ACE inhibitors have a modest blood pressure lowering effect

Clinical question: 
How effective are angiotensin converting enzyme (ACE) inhibitors in lowering blood pressure (BP) in primary hypertension?
Bottom line: 
Compared to placebo, the BP lowering effect of ACE inhibitors is modest; the magnitude of trough BP lowering at one half the manufacturers' maximum recommended dose and above is -8mmHg for systolic BP and -5mmHg for diastolic BP. Furthermore, 60 to 70% of this trough BP lowering effect occurs with recommended starting doses. No ACE inhibitor appears to be any better or worse in terms of BP lowering ability.
Caveat: 
Due to lack of reporting and the short duration of these trials (3 to 12 weeks), this review did not provide a good estimate of the harms associated with this class of drugs.
Context: 
ACE inhibitors are commonly used for the treatment of elevated blood pressure. This class includes drugs such as ramipril, captopril, enalapril, fosinopril, lisinopril and quinapril. Despite over 20 years of research evidence and clinical use of ACE inhibitors, the dose-related BP lowering effect of this antihypertensive drug class is still not known.
Review CD#: 
CD003823
PEARLS No: 
123
Date: 
November, 2008
Authored by: 
Brian R McAvoy