Current Perspective on the Use of Angiotensin-Converting Enzyme Inhibitors in the Management of Coronary (Atherosclerotic) Artery Disease

1997 ◽  
Vol 31 (12) ◽  
pp. 1499-1506 ◽  
Author(s):  
Judy WM Cheng ◽  
Mimi N Ngo
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Ace Inhibitors ◽  
English Language ◽  
Data Extraction ◽  
Renin Angiotensin System ◽  
Therapeutic Monitoring ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Beneficial Effects

OBJECTIVE: To review the pathophysiology of atherosclerosis, the role of the renin—angiotensin system in atherogenesis, and studies supporting the potential beneficial effects of angiotensin-converting enzyme (ACE) inhibitors in reducing cardiovascular events with long-term use. BACKGROUND: Through its action in converting angiotensin I to angiotensin II and by degrading bradykinin, local tissue ACE exerts many effects that can contribute to the development of atherosclerosis. Therefore, the use of ACE inhibitors can possibly result in antiatherogenic effects. Possible mechanisms for antiatherogenic effects of ACE inhibitors include: (1) reduction of blood pressure; (2) antiproliferative and antimigratory effects on vascular smooth muscle cells, neutrophils, and monocytes; (3) restoration of endothelial function; (4) stabilization of fatty plaque by preventing vasoconstriction; (5) antiplatelet effects; and (6) enhancement of endogenous fibrinolysis. DATA SOURCES: English-language clinical studies, abstracts, and review articles pertaining to the use of ACE inhibitors and atherosclerosis. STUDY SELECTION AND DATA EXTRACTION: Relevant human studies examining the role of ACE inhibitors and atherosclerosis. DATA SYNTHESIS: Studies evaluating the possible beneficial effects of ACE inhibitors in the development of atherosclerosis are reviewed and critiqued. Design of ongoing studies with clinical and surrogate end points are discussed. CONCLUSIONS: Based on current published studies, recommendations are made regarding the use of ACE inhibitors in atherosclerosis. Therapeutic monitoring parameters for efficacy and adverse effects are also reviewed.

Endocrinologic Warfare: The Role of Angiotensin-Converting Enzyme Inhibitors in Congestive Heart Failure

1990 ◽  
Vol 3 (5) ◽  
pp. 318-331
Author(s):  
Mark A. Munger ◽  
Stephanie F. Gardner ◽  
Robert C. Jarvis
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Ace Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Vasodilator Therapy ◽  
The Future

The angiotensin-converting enzyme (ACE) inhibitors represent the gold standard of vasodilator therapy for congestive heart failure through blunting of the endocrinologic manifestations of heart failure. The future role of these agents may be in the asymptomatic and mild stages of heart failure. ACE inhibitors have been shown to decrease morbidity and mortality with the natural history of this disease being altered. The future will bring many new ACE inhibitors to market, with the challenge for physicians and pharmacists to understand the important distinctions of each specific agent. © 1990 by W.B. Saunders Company.

Role of Race in the Pharmacotherapy of Heart Failure

2002 ◽  
Vol 36 (3) ◽  
pp. 471-478 ◽  
Author(s):  
James S Kalus ◽  
Jean M Nappi
Keyword(s):  
Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Ace Inhibitors ◽  
English Language ◽  
Systolic Heart Failure ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Medline Search ◽  
Black Patients ◽  
Β Blockers

OBJECTIVE: To review the literature assessing the differences in response to angiotensin-converting enzyme (ACE) inhibitors and β-blockers in black patients compared with the response in non-black patients in the management of systolic heart failure. DATA SOURCES: A MEDLINE search (January 1966–May 2001) was performed using heart failure, blacks, Negroid race, adrenergic β-antagonists, and angiotensin-converting enzyme inhibitors as key words. English-language articles were identified. Additional pertinent articles were identified from review of the references of these articles. STUDY SELECTION AND DATA EXTRACTION: All identified references were reviewed. All articles deemed relevant to the subject of this article were included. DATA SYNTHESIS: It has been suggested that the antihypertensive effect of ACE inhibitors and β-blockers may be less in black patients than in other racial groups. Retrospective reanalyses of major heart failure trials have suggested that black patients may not realize a significant benefit in morbidity or mortality when heart failure is managed with ACE inhibitors or β-blockers. It has also been suggested that black patients may respond more favorably than non-black patients to the combination of hydralazine and isosorbide dinitrate. CONCLUSIONS: Published reanalyses of ACE inhibitor and β-blocker trials in heart failure provide weak data to support a lack of benefit in black patients. The published literature on this topic is limited by its retrospective nature. Firm conclusions regarding the influence of race on effectiveness of ACE inhibitors and β-blockers cannot be made until prospective trials, with planned analysis of the effect of race, have been performed.

Angiotensin-converting enzyme and the tumor microenvironment: mechanisms beyond angiogenesis

2013 ◽  
Vol 305 (3) ◽  
pp. R205-R215 ◽  
Author(s):  
Derick Okwan-Duodu ◽  
Jerome Landry ◽  
Xiao Z. Shen ◽  
Roberto Diaz
Keyword(s):  
Tumor Microenvironment ◽  
Substance P ◽  
Angiotensin Converting Enzyme ◽  
Ace Inhibitors ◽  
T Regulatory Cells ◽  
Suppressor Cells ◽  
Renin Angiotensin System ◽  
Ace Inhibition ◽  
Converting Enzyme

The renin angiotensin system (RAS) is a network of enzymes and peptides that coalesce primarily on the angiotensin II type 1 receptor (AT1R) to induce cell proliferation, angiogenesis, fibrosis, and blood pressure control. Angiotensin-converting enzyme (ACE), the key peptidase of the RAS, is promiscuous in that it cleaves other substrates such as substance P and bradykinin. Accumulating evidence implicates ACE in the pathophysiology of carcinogenesis. While the role of ACE and its peptide network in modulating angiogenesis via the AT1R is well documented, its involvement in shaping other aspects of the tumor microenvironment remains largely unknown. Here, we review the role of ACE in modulating the immune compartment of the tumor microenvironment, which encompasses the immunosuppressive, cancer-promoting myeloid-derived suppressor cells, alternatively activated tumor-associated macrophages, and T regulatory cells. We also discuss the potential roles of peptides that accumulate in the setting of chronic ACE inhibitor use, such as bradykinin, substance P, and N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP), and how they may undercut the gains of anti-angiogenesis from ACE inhibition. These emerging mechanisms may harmonize the often-conflicting results on the role of ACE inhibitors and ACE polymorphisms in various cancers and call for further investigations into the potential benefit of ACE inhibitors in some neoplasms.

New fACEs to the Renin-Angiotensin System

Physiology ◽  
2005 ◽  
Vol 20 (2) ◽  
pp. 91-95 ◽  
Author(s):  
Ingrid Fleming ◽  
Karin Kohlstedt ◽  
Rudi Busse
Keyword(s):  
Angiotensin Ii ◽  
Cardiovascular Diseases ◽  
Angiotensin Converting Enzyme ◽  
Kidney Function ◽  
Ace Inhibitors ◽  
Renin Angiotensin System ◽  
Signaling Cascade ◽  
Converting Enzyme ◽  
Angiotensin System ◽  
Beneficial Effects

Inhibition of the angiotensin-converting enzyme (ACE) protects against the progression of several cardiovascular diseases. Recent evidence suggests that some of the beneficial effects of ACE inhibitors can be attributed to the activation of a distinct ACE signaling cascade rather than to the changes in angiotensin II and bradykinin levels. Moreover, at least one other ACE homolog (ACE2) plays a significant role in the regulation of heart and kidney function.

scholarly journals Angiotensin-converting enzyme inhibitors or sartans in patients at high risk for cardiovascular events: a wrong question or an undesirable answer

2013 ◽  
Vol 10 (1) ◽  
pp. 35-38
Author(s):  
S R Gilyarevsky ◽  
V A Orlov ◽  
I M Kuzmina ◽  
M V Golshmid
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Cardiovascular Events ◽  
Enzyme Inhibitors ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

The paper discusses current views on the role of using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers to prevent severe cardiovascular events. It gives both respective documentary information and experts’ opinions. The possible causes of clinical inertness defining deviations in the tactics of using drugs that suppress the activity of the renin-angiotensin system are considered.

scholarly journals The role of renin-angiotensin system and angiotensin-converting enzyme 2 (ACE2) in the development and course of viral infection COVID-19 in patients with diabetes mellitus

2020 ◽  
Vol 23 (3) ◽  
pp. 242-249
Author(s):  
O. K. Vikulova ◽  
Zamira Zuraeva ◽  
L. V. Nikankina ◽  
M. V. Shestakova
Keyword(s):  
Diabetes Mellitus ◽  
Angiotensin Converting Enzyme ◽  
Viral Infection ◽  
Ace Inhibitors ◽  
Renin Angiotensin System ◽  
Converting Enzyme ◽  
Angiotensin System ◽  
Angiotensin Converting Enzyme 2 ◽  
Renin Angiotensin

The role of renin-angiotensin system (RAS) in general and angiotensin-converting enzyme 2 (ACE2) in particular in the pathogenesis and course of viral infection caused by SARS-CoV-2 (COVID-19) is of particular interest. This is due not only to the fact that ACE2 is a receptor for the virus the target cells. RAS hyperactivation in patients with arterial hypertension, cardiovascular disease and diabetes mellitus, is considered one of the most important factors for a more severe infection in persons with concomitant pathology. In addition, the effects of PAS blockage with angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs) remains one of the most discussed topics in the literature on COVID-19. Thisreview presents the data on the interaction between the virus and the main components of RAS and the factors influencing their expression level, the impact of ACE inhibitors and ARBs therapy on the disease outcome, and presents theperspectives of the treatment with recombinant ACE 2.

Angiotensin-Converting Enzyme Inhibitors in Diabetic Nephropathy

1993 ◽  
Vol 27 (3) ◽  
pp. 344-350 ◽  
Author(s):  
Wayne R. Melchior ◽  
Vinita Bindlish ◽  
Linda A. Jaber
Keyword(s):  
Diabetic Nephropathy ◽  
Angiotensin Converting Enzyme ◽  
Ace Inhibitors ◽  
English Language ◽  
Ace Inhibitor ◽  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Inhibitor Therapy ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors

OBJECTIVE: Diabetic nephropathy (DN) is a leading cause of kidney disease in the US. At least four factors influence whether people with diabetes will develop DN: (1) hypertension, (2) hyperglycemia, (3) dietary protein intake, and (4) intrarenal hemodynamics. The angiotensin-converting enzyme (ACE) inhibitors are known to affect blood pressure (BP) and intrarenal hemodynamics; thus, they may prevent the onset of DN or slow the decline in renal function once DN has been diagnosed. DATA SOURCES: English-language, controlled, and crossover studies published between 1973 and 1991 and indexed in MEDLINE under the headings diabetic nephropathies and angiotensin-converting enzyme inhibitors. MAIN OUTCOME MEASURES: The primary outcome indicators of interest were the effects of the ACE inhibitors captopril, enalapril, and lisinopril on BP control and urinary albumin excretion rate. CONCLUSIONS: ACE inhibitors delay the onset and slow the progression of DN in people with diabetes independent of BP effects. They also slow the progression of DN in people with diabetes who have poorly controlled hyperglycemia. The proper dose and time at which to initiate ACE inhibitor therapy to prevent the appearance of DN is not known. It is also not known how long the beneficial effects of ACE-inhibitor therapy persists as only two studies have followed patients for more than one year. Finally, large, long-term, controlled clinical trials are needed before ACE inhibitors can be considered for prophylactic use to prevent the onset and/or progression of DN.

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