Knowing When to Play the Ace: The Use and Under Use of Ace Inhibitors in Primary Practice

The role of angiotensin-converting enzyme (ACE) inhibitors has expanded beyond the original indication of hypertension. Landmark studies and practice guidelines recommend the use of ACE inhibitors in patients with heart failure, post-myocardial infarction, and post-cerebrovascular accident to decrease morbidity and mortality. However, despite a sizable amount of literature and presence in treatment guidelines, this class of medications has been traditionally underused in the primary care setting. It is for this reason that pharmacists should play a more active role in increasing appropriate ACE inhibitor usage through interventions. Second, the idea that ACE inhibitors display a “class effect” is often used to justify interchange from one particular medication to another. However, there are structural differences and pharmacokinetic nuances that should not be understated. The objective of this article is to outline uses of ACE inhibitors beyond hypertension, discuss the under use of this class despite existing literature, and touch on the idea of class effect among ACE inhibitors.