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August 1991

All ACE Inhibitors Are Not Alike-Reply

Author Affiliations

Fresno, Calif

Arch Intern Med. 1991;151(8):1670-1672. doi:10.1001/archinte.1991.00400080150036

In Reply.—  The comments by Cheng are quite valid and further emphasize the differences between various angiotensin-converting enzyme inhibitors. Although the presence of the sulfhydryl group in captopril has been shown to contribute to captopril's capacity to act as a free radical scavenger,12 the clinical significance of this phenomenon is not established. In the study by McMurray et al,2 the investigators evaluated 29 patients with chronic congestive heart failure by measurement of plasma malondialdehyde (an indirect indicator of free radical-mediated damage to lipids) and demonstrated that, compared with (Continued from p 1670.) healthy control subjects, the patients with congestive heart failure had higher plasma malondialdehyde and lower thiol concentrations (P<.05). Although it is true that increased free radical activity in patients with congestive heart failure may have important implications since free radicals cause impairment of myocyte metabolism and contraction,3 there is as yet little available information

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