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 ?
Heart failure treatment with angiotensin-converting enzyme inhibitors in hospitalized Medicare patients in 10 states.
Angiotensin-converting enzyme inhibitors (ACEIs) and beta blockers remain the two most important therapies for patients with chronic HF.
Systematic Review: Comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension.
Start patients on a half tablet daily of the lowest dose available for a fixed-dose combination of a diuretic plus either an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker.
of patients 371 Age range (mean) 44-92 yr (mean age, 67 yr) Sex ratio 1:1 (178 males, 193 females) Time frame July 1996-December 1997 (18 mo) Discharge diagnosis Congestive heart failure Comorbid diagnoses Chronic lung disease, pneumonia, coronary artery disease, anemia, renal insufficiency, diabetes, hypertension Exclusion criteria Peripartum cardiomyopathy, hemodialysis, intolerance to angiotensin-converting enzyme inhibitors, readmission for congestive heart failure
The effects of the angiotensin-converting enzyme inhibitor imidapril on plasma plasminogen activator inhibitor activity in patients with acute myocardial infarction.
001 (a)LVFE, left ventricular function evaluation NH, nursing home CAD, coronary artery disease Table 2 Patient characterists by use of angiotensin-converting enzyme inhibitor (a) All patients Not taking ACEI at Demographic characteristic (n = 1,090) discharge (n = 562) Mean age (yr) 79.
All participantsb were also assigned to take 1 of 3 antihypertensive agents: 441 received the eta-blocker metoprolol; 436 received the angiotensin-converting enzyme inhibitor ramipril, and 217 received the dihydropyridine calcium channel blocker amlodipine.
In separate clinical trials in patients with mild to moderate hypertension, omapatrilat lowered systolic and diastolic blood pressure significantly more than an angiotensin-converting enzyme inhibitor or a calcium channel blocker.
An angiotensin-converting enzyme inhibitor approved for reducing the risk of cardiovascular mortality or nonfatal MI in patients with stable coronary artery disease.
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.
NEW ORLEANS -- Angiotensin-converting enzyme inhibitor therapy markedly reduces the rate of shocks for ventricular arrhythmias in patients with an implantable cardioverter defibrillator, Dr.

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