Ramipril: review of pharmacology.

Ramipril is a potent orally active converting enzyme inhibitor. Its active metabolite ramiprilat is classified as a reversible, slow- and tight-binding inhibitor. Ramipril lowers blood pressure in various models of hypertension and improves states of acute cardiac failure mainly by suppression of angiotensin II formation. Actions on both vasoconstrictor and volume factors are involved because ramipril causes vasodilation and mild natriuresis but preserves potassium. Sustained inhibition of converting enzyme in target tissues such as vascular wall, kidney and heart may explain cardiovascular changes over the long term. Ancillary effects may possibly emerge from modulation of the sympathetic nervous system but the contribution of bradykinin potentiation remains unclear.