Structure and Function of Angiotensin Converting Enzyme and Its Inhibitors

The aim of the present study was to assess the effect of treatment with the angiotensin II receptor blocker telmisartan for 24 weeks on myocardial structure and function in patients with essential hypertension, and the relationship between this effect and the structural polymorphism of the angiotensin-converting enzyme (ACE) gene. Thirty-five patients with essential hypertension and left ventricular hypertrophy (LVH) without other associated morbidity were included in an open-label, non-comparative study. The patients were treated with telmisartan 40-80 mg once daily. In the final analysis, there were 29 patients who received the full course of treatment and were evaluated echocardiographically before and after treatment by the same blinded investigator, and myocardial structure and function were analysed. The myocardial mass of the left ventricle was determined in M-mode. Assessment of diastolic function of transmitral blood flow was performed using pulsed Doppler echocardiography. All patients were genotyped for insertion/deletion (I/D) polymorphism of the ACE gene. Telmisartan produced a significant reduction in left ventricular mass index from 140.4 ± 48.6 to 128.7 ± 40.6 g/m2 that was accompanied by an improvement in characteristics of diastolic function. The decrease in LVH was more significant in the ID genotype group than in the II and DD groups. Thus, prolonged treatment with telmisartan is accompanied by an improvement in myocardial structure, expressed as a reduction in left ventricular mass and function that is more marked in patients with ID genotype of the ACE gene.

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Diabetic Nephropathy Induced by IncreasedAceGene Dosage Is Associated with High Renal Levels of Angiotensin (1–7) and Bradykinin

Journal of Diabetes Research ◽

10.1155/2015/674047 ◽

2015 ◽

Vol 2015 ◽

pp. 1-13 ◽

Cited By ~ 9

Author(s):

Nádia Bertoncello ◽

Roseli Peres Moreira ◽

Danielle Yuri Arita ◽

Danielle S. Aragão ◽

Ingrid Kazue Mizuno Watanabe ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetic Nephropathy ◽

Angiotensin Converting Enzyme ◽

Renal Dysfunction ◽

Population Studies ◽

Structure And Function ◽

Diabetic Group ◽

Ang Ii ◽

Converting Enzyme ◽

And Function

Population studies have shown an association between diabetic nephropathy (DN) and insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene (ACEin humans,Acein mice). The aim was to evaluate the modulation ofAcecopies number and diabetes mellitus (DM) on renal RAS and correlate it with indicators of kidney function. Increased number of copies of theAcegene, associated with DM, induces renal dysfunction. The susceptibility to the development of DN in 3 copies of animals is associated with an imbalance in activity of RAS enzymes leading to increased synthesis of Ang II and Ang-(1–7). Increased concentration of renal Ang-(1–7) appears to potentiate the deleterious effects triggered by Ang II on kidney structure and function. Results also show increased bradykinin concentration in 3 copies diabetic group. Taken together, results indicate that the deleterious effects described in 3 copies diabetic group are, at least in part, due to a combination of factors not usually described in the literature. Thus, the data presented here show up innovative and contribute to understanding the complex mechanisms involved in the development of DN, in order to optimize the treatment of patients with this complication.

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