Ján Murín, Jozef Bulas
Introduction of angiotensin converting enzyme inhibitors (ACEI) to treatment has brought a significant decrease of morbidity and mortality for several cardiovascular diseases. This benefit has been demonstrated by big randomized controlled trials (RCT) in which several medicament have been used. On the basis of differences between used molecules (medicaments), a discussion has been arisen if it is possible to extrapolate trial results with a specific molecule to other molecules (and thus also to other medicaments) inhibiting ACE and therefore to bring forward the argument of the effect of so-called class effect or to attribute the trial results to characteristic properties of the used medicament. Indubitable basis of the ACE inhibitors’ effect is so-called “class effect” even if there exist differences between particular molecules namely in pharmacokinetics (e.g. lipophilicity and penetration to tissues, bonds in tissues, half -time of the effect, metabolism and main mechanisms of excretion). According to the results of big RCTs in the approach of evidence-based medicine, molecules, with which these trials were performed, succeeded in the treatment of some clinical conditions, on the basis of reasoning that certain differences in the molecule properties besides the angiotensin convertase enzyme inhibition they might also provide a certain additive, more closely unspecified pharmacokinetic effect. Knowledge of the differences between particular molecules of ACE inhibitors should be taken into consideration in the choice of a suitable medicament for the particular patient.