angiotensin-converting enzyme inhibitor

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angiotensin-converting enzyme (ACE) inhibitor

a protease inhibitor found in serum that promotes vasodilation by blocking the formation of angiotensin II and slowing the degradation of bradykinin and other kinins. It decreases sodium retention, water retention, blood pressure, and heart size and increases cardiac output.

ACE inhibitor

Angiotensin-converting enzyme inhibitor. Any of a family of drugs used to manage hypertension and reduce congestive heart failure (CHF)-related mortality and morbidity.

Examples
Bepridil, captopril, enalapril, lisionopril, losartan, quinapril, ramipril.

ACE inhibitor Effects in Heart Disease
Cardioprotective effects
• Restores balance between myocardial O2 supply and demand;
• Reduces left ventricular preload and afterload;
• Reduces left ventricular mass;
• Reduces sympathetic stimulation.
Vasculoprotective effects
• Antiproliferative and antimigratory effects on smooth muscle and inflammatory cells;
• Antiplatelet effects;
• Improved arterial compliance and tone;
• Improved and/or restored endothelial function;
• Antihypertensive;
• Possible antiatherosclerotic effect. 

Pros
ACEIs are cardioprotective and vasculoprotective; cardioprotective effects include improved haemodynamics and electric stability, reduce sympathetic nervous system (SNS) activity and reduce left ventricular mass; vasculoprotective benefits include improved endothelial function, vascular compliance and tone, and direct antiproliferative and antiplatelet effects. ACEIs also stimulate prostaglandin (PG) synthesis, reduce the size of MIs, and reduce reperfusion injury and complex ventricular arrhythmias.

ACEIs are the treatment of choice in CHF with systolic dysfunction; they are vasodilators which decrease preload and afterload. ACEI-induced reduction in angiotensin II inhibits the release of aldosterone, which in turn reduces sodium and water retention which, by extension, reduce preload; ACEIs improve haemodynamics of CHF by reducing right atrial pressure, pulmonary capillary wedge pressure, arterial BP, as well as pulmonary and systemic vascular resistance; ACEIs increase cardiac and stroke indices by the left ventricle and reduce the right ventricular end-diastolic volumes, thereby increasing cardiac output, while simultaneously reducing cardiac load and myocardial O2 consumption.
 
Adverse effects
• Idiopathic—e.g., rashes, dysgeusia, BMsuppression.
• Class-specific—e.g., hypotension, renal impairment, hyperkaleamia, cough, angioneurotic oedema (the latter 2 of which are mediated by small vasoactive substances—e.g., bradykinin, substance P, and PG-related factors).

Angiotensin-converting enzyme (ACE) inhibitor

A drug that relaxes blood vessel walls and lowers blood pressure.

angiotensin-converting enzyme inhibitor

; ACE inhibitor pharmacological agent preventing conversion of angiotensin I to angiotensin II (thereby controlling vasoconstriction and reducing blood pressure), used in the treatment of heart failure, hypertension (especially diabetic patients with associated nephropathy) and in the long-term management of patients with myocardial infarction; used with care in patients on diuretics and those with renal dysfunction
References in periodicals archive ?
Perhaps it's a worthwhile addition in patients who have high (on-treatment) blood pressures, but with that exception ARBs are a therapy for the CHF patient who cannot take an ACE inhibitor.
Taken together with two earlier clinical trials, there can be no doubt that an ARB is a good alternative in patients unable to tolerate an ACE inhibitor.
The Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM)-Added trial involved 2,548 patients with symptomatic CHF and a left ventricular ejection fraction of 40% or less who were being treated with an ACE inhibitor.
in November, 1991, and has become the fastest-growing ACE inhibitor.
This is the evidence that we need to make the strong statement that all patients with coronary disease should be treated with an ACE inhibitor.
Merck's Vasotec (enalapril maleate) is America's most widely used product for the treatment of hypertension and also is the most- prescribed ACE inhibitor.