The introduction of angiotensin-converting enzyme (ACE) inhibitors has had an appreciable impact upon the treatment of hypertension in Europe, although acceptance of these new agents has not been uniform in all countries. In order to arrive at an understanding of the place of ACE inhibitors in the management of the hypertensive patient, the attitudes of four parties must be considered: the prescriber, the patient, the manufacturer, and the regulatory agency. Physicians in Britain, Germany, and Scandinavia have lagged behind their counterparts in France and Italy in prescribing ACE inhibitors, due to restrictions placed by national regulatory agencies on the first-line use of these agents in hypertension therapy.
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