Who needs nine ACE inhibitors?

Nine angiotensin-converting enzyme (ACE) inhibitors are now marketed in the UK. The first, captopril, was introduced in 1981.1 Then followed enalapril,2 lisinopril,3 quinapril, perindopril and ramipril4 and, most recently, cilazapril, fosinopril and ▼trandolapril. Their place in the treatment of patients with heart failure5,6 and hypertension7 is now established, and a new indication as part of the treatment of myocardial infarction is increasingly being recognised. In this article we review the ACE inhibitors and ask if all nine are really needed.