ABSTRACT

Inhibitors of converting enzyme, or kininase II, commonly called angiotensinconverting enzyme (ACE) inhibitors, were first developed in the late 1970s as a specific pharmacological treatment to lower blood pressure in a subset of hypertensive patients with elevated renin (1). Over the past two decades, as a consequence of intense basic and clinical investigations, it has now become clear that these agents have a much greater therapeutic effect than originally conceived. Indeed, ACE inhibitors are currently considered as life-saving and morbidityreducing therapies for patients with heart failure, asymptomatic left ventricular dysfunction, acute and chronic myocardial infarction, diabetes, and other forms of nephropathy. Most recently, this list of beneficiaries has been expanded to the broad population of patients with vascular disease or diabetes and a concomitant risk factor. These impressive accomplishments stem from a series of international multicenter trials generating consistent information regarding survival and other important clinical outcome benefits with the use of these compounds. This chapter will provide an overview of these accomplishments and then focus on one of the current issues that is particularly relevant to these proceedings on thrombosis and thromboembolism-the question of a potential aspirin-ACE-inhibitor negative interaction.