![]() ![]() 16 However, with long-term therapy, a greater percentage of patients achieve a decrease in BP, and the antihypertensive effect no longer correlates with pretreatment plasma renin activity. 12, 13, 14, 15 In support of this, co-administration of drugs that increase plasma renin activity, such as diuretics, abolishes the racial differences in response to ACEis. 9, 10, 11 The acute change in BP correlates with pretreatment plasma renin activity and angiotensin levels, such that the greatest reductions in BP are seen in patients with the highest plasma renin activity. 8ĪCEis are effective in lowering the mean, systolic and diastolic pressures in hypertensive patients as well as in salt-depleted normotensive subjects. 7 The Antihypertensive and Lipid Lowering Therapy in Heart Attack Trial (ALLHAT) also suggests the use of ACEis as initial therapy alone or in combination with thiazide diuretics, with an overall response of 50–70% in mild to moderate disease. Patients with stage-I hypertension (systolic blood pressure (BP): 140–159 or diastolic BP: 90–99 mmHg) should be treated with ACEis. This review traces some already known and new facets of ACE inhibition and introduces new advances in the designing of a new generation of ACEis.Īccording to The Joint National Committee (JNC) VII, ACEis are one of the first-line drugs for hypertension. Some new studies have expanded the already impressive clinical profile of ACEis. ![]() Recently, the discovery of domain-selective ACEis and new members of the renin–angiotensin system (RAS) (that is, angiotensin-converting enzyme 2) have again fueled the interest of researchers. 3, 4 ACE inhibitors (ACEis) have been in use for the past two decades, and the interest in them is still growing. 2Ī number of therapies are available, but angiotensin-converting enzyme (ACE) inhibitors have been the preferred first-line therapy for hypertension, congestive heart failure, left ventricular (LV) systolic dysfunction and MI. Long-standing and stressful, progressively rising hypertension can lead to many disorders, including myocardial infarction (MI), cerebrovascular events, congestive heart failure, peripheral arterial insufficiency, premature mortality 1 and renal dysfunction leading to glomerulosclerosis and kidney artery aneurysm. In recent years, stressful and fiercely competitive lifestyles and food habits have compounded the problems of hypertension. Lastly, N- and C-domain selective ACE inhibitors have led to new uses for ACE inhibitors. Ongoing studies have elucidated protective roles for them in both memory-related disorders and cancer. Furthermore, they delay the progression of diabetic nephropathy and neuropathy and act as antioxidants. They inhibit ischemic events and stabilize plaques. They have been proven effective in the treatment of hypertension, and reduce mortality in congestive heart failure and left ventricular dysfunction after myocardial infarction. ACE inhibitors decrease systemic vascular resistance without increasing heart rate and promote natriuresis. As ACE is a promiscuous enzyme, ACE inhibitors alter the metabolism of a number of other vasoactive substances. They restore the balance between the vasoconstrictive salt-retentive and hypertrophy-causing peptide angiotensin II (Ang II) and bradykinin, a vasodilatory and natriuretic peptide. Since their inception, angiotensin-converting enzyme (ACE) inhibitors have been used as first-line therapy for the treatment of cardiovascular and renal diseases. ![]()
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |