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.

Mentioned in: Congestive Cardiomyopathy, Heart Failure

Mentioned in

References in periodicals archive

Angiotensin-converting enzyme inhibitors in the management of cardiac failure: are we ignoring the evidence?

Use of angiotensin-converting enzyme inhibitors in elderly patients with heart failure

The patients were randomized to treatment with either a combination of the angiotensin-converting enzyme inhibitor trandolapril and the sustained-release formulation of verapamil, a calcium channel blocker, or HCTZ plus the ARB losartan.

In hypertensives with impaired glucose, skip thiazide diuretics

In patients who have either chronic stable angina without a history of myocardial infarction or a revascularization procedure in the past 6 months, as well as in asymptomatic patients with demonstrated coronary artery disease, the following should be routine: aspirin; a betablocker; an angiotensin-converting enzyme inhibitor; and a statin, if the cholesterol is above normal.

Guidelines for the treatment of chronic stable angina

-- Combination antihypertensive therapy with a calcium channel blocker and angiotensin-converting enzyme inhibitor provides important clinical outcome advantages over the traditional [beta]-blocker/diuretic combination, Peter S.

ASCOT findings put new spin on HT combination therapy

Does adding an angiotensin-converting enzyme inhibitor improve outcomes among patients with stable angina and no evidence of heart failure?

Adding ACE inhibitor doesn't improve outcomes in stable angina and normal LVEF

An angiotensin-converting enzyme inhibitor approved for reducing the risk of cardiovascular mortality or nonfatal MI in patients with stable coronary artery disease.

Aceon

More than 90% of patients in both the anemia and normal hemoglobin groups were treated with an angiotensin-converting enzyme inhibitor and with a [beta]-blocker.

Anemia tied to mortality in younger heart failure patients

In the Carvedilol or Metoprolol European Trial (COMET), (1) patients with heart failure were randomized to receive either carvedilol or metoprolol in addition to their current diuretic and angiotensin-converting enzyme inhibitor. A visual comparison of the survival curves shows a reduction in mortality in the carvedilol group compared with those in the metoprolol group (Figure 1).

Estimating mortality reduction by comparing survival curves

Patients identified with proteinuria began treatment with either an angiotensin-converting enzyme inhibitor or an angiotensin II-receptor blocker.

Annual proteinuria screening not cost-effective

Men who have erectile dysfunction are good candidates for aggressive treatment with a statin and with either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker.

Erectile dysfunction may presage vascular dysfunction: begin aggressive statin treatment

VIENNA -- Treatment with an angiotensin-converting enzyme inhibitor cut the incidence of new-onset diabetes in a controlled trial of more than 22,000 patients with hypertension and coronary artery disease.

ACE inhibitor may reduce new-onset diabetes: hydrochlorothiazide may raise risk

* RESULTS We found that patients who could derive the greatest benefit from testing (ie, those without preexisting proteinuria or who were not receiving an angiotensin-blocking drug) were no more likely to be screened for microalbuminuria than those with existing proteinuria (16% vs 18%, P=.84) or those who were already being treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (16% vs 16%, P=.83).

Use of Microalbuminuria Testing in Persons with Type 2 Diabetes