A.D. Radchenko Is it necessary to refuse from “old” angiotensin-converting enzyme inhibitors and choose “new” ones?

Because of active promotions by large pharmaceutical companies, last time many physicians receive a lot of information about much more benefits of “new” ACE inhibitors than “old” ones and about their “unique” action
mechanisms. This article reviews data answering following questions: what do pharmacokinetic and pharmacodynamic characteristics of different ACE inhibitors mean for clinics? Are any differences in blood
pressure reduction or blood pressure additional parameters result in differences of ACE inhibitor effects? Is any “unique” quality, that has only one ACE inhibitors and that is independent from its blood pressure reduction effects? Do we need to refuse from using “old” ACE inhibitors for the benefits of “new” ones? In conclusion, despite different chemical structures and pharmacokinetics, most ACE inhibitors are equal in treatment of cardiovascular and concomitant pathology. There are only less and more studied drugs. And “old” ACE inhibitors are mot the worst. They decreased blood pressure as the “new” ones; they could be used once daily, they have the same proved clinical database of their effectiveness in patients with arterial hypertension, diabetes mellitus, heart failure or systolic dysfunction. They improve prognosis of patients with myocardial infarction and could be administered during the first day, contrary to “new” ACE inhibitors. Because of these, it is not necessary to refuse from using of “old” drugs for benefits of “new” ones. Especially it is not feasible in Ukraine, the country where patients buy drugs themselves. “Old” ACE inhibitors have many generics, which cost less.

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