Angiotensin-converting enzyme inhibitor

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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).
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.

Angiotensin-converting enzyme (ACE) inhibitor

A drug that relaxes blood vessel walls and lowers blood pressure.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
References in periodicals archive ?
And men who were treated with an ACE inhibitor were about 60% less likely to have ED than were men who did not receive an ACE inhibitor.
In fact, I'd conclude that VALIANT confirms the earlier Val-HeFT finding: It just doesn't make much sense to add an ARB in most patients with heart failure who are on an ACE inhibitor.
Approval was based on a subgroup of about 370 patients who were not on an ACE inhibitor. In these patients, Diovan therapy was associated with a 49% reduction in morbidity a 41% reduction in all-cause mortality and a 57% reduction in first hospitalization for heart failure, said Dr.
CHARM Added was for patients with an ejection fraction of 40% or less who were on an ACE inhibitor. CHARM-Preserved enrolled patients with CHF who had an ejection fraction greater than 40%, a common condition often called diastolic dysfunction.
The incidence of angioedema was similar to what is seen among patients treated with an ACE inhibitor. But the angioedema that is associated with ACE inhibitor treatment is never severe enough to need intubation, Ms.
The onset of cough can occur 3 days to 12 months after starting use of an ACE inhibitor. The cough usually subsides within 4 weeks of stopping the drug.