Introduction to focused issue

Abstract

Since their introduction in 1977 [1], the angiotensin converting enzyme (ACE) inhibitors have rapidly gained acceptance as suitable initial drug therapy for the treatment of high blood pressure [2]. Furthermore, they are becoming important members of a therapeutic armamentarium designed not only to lower blood pressure, but also to prevent and/or attenuate the development of hypertension end-organ damage. It is this latter theme that provided the rationale for the inception, birth, and growth of this particular focused issue on ACE inhibitors. To set the stage, this focused issue begins with a scholarly review by Dr. Gurdarshan Thind on the comparative structure, pharmacokinetics, and pharmacodynamics of three commercially available but chemically different ACE inhibitors. The focused issue then follows with three in-depth reviews on the renal effects of ACE inhibitors in a) essential hypertension (Drs. Garry Reams and John Bauer), b) nondiabetic chronic renal disease (Drs. John Opshal, Paul Abraham, and William Keane) and c) renovascular hypertension (Dr. Stephen Textor). Each of these investigators provide a review and assessment of the literature in their respective areas of research. The focused issue then proceeds with an informative and provocative review of the effects of ACE inhibitors on vascular smooth muscle structure in hypertension (Drs. Garry Gibbons and Victor Dzau). Finally, this issue concludes with a personal but balanced assessment on the cardiac effects of ACE inhibitors (Dr. Norman Sharpe). Each of these authors brings to the reader not only the fruits of his scholarly research, but also his clinical interpretation of the data. To each of them, I express my appreciation for allowing me to combine their individual expertise into one publication assessing the effects of ACE inhibitors on hypertensive endorgan structure and function.