ACE inhibitor

Last updated

Angiotensin-converting-enzyme inhibitor
Drug class
Captopril skeletal.svg
Captopril, the first synthetic ACE inhibitor
Class identifiers
Use Hypertension
ATC code C09A
Biological target Angiotensin-converting enzyme
Clinical data
Drugs.com Drug Classes
Consumer Reports Best Buy Drugs
WebMD MedicineNet   RxList
External links
MeSH D000806
Legal status
In Wikidata

Angiotensin-converting-enzyme inhibitors (ACE inhibitors) are a class of medication used primarily for the treatment of high blood pressure and heart failure. [1] [2] This class of medicine works by causing relaxation of blood vessels as well as a decrease in blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart.

Contents

ACE inhibitors inhibit the activity of angiotensin-converting enzyme, an important component of the renin–angiotensin system which converts angiotensin I to angiotensin II, [3] and hydrolyses bradykinin. [1] Therefore, ACE inhibitors decrease the formation of angiotensin II, a vasoconstrictor, and increase the level of bradykinin, a peptide vasodilator. [1] [3] This combination is synergistic in lowering blood pressure. [1] [3]

As a result of inhibiting the ACE enzyme in the bradykinin system, the ACE inhibitor drugs allow for increased levels of bradykinin which would normally be degraded. Bradykinin produces prostaglandin. This mechanism can explain the two most common side effects seen with ACE Inhibitors: angioedema and cough.

Frequently prescribed ACE inhibitors include benazepril, zofenopril, perindopril, trandolapril, captopril, enalapril, lisinopril, and ramipril.

Medical use

ACE inhibitors were initially approved for the treatment of hypertension and can be used alone or in combination with other anti-hypertensive medications. Later, they were found useful for other cardiovascular and kidney diseases [4] including:

In treating high blood pressure, ACE inhibitors are often the first drug choice, particularly when diabetes is present, [8] but age can lead to different choices and it is common to need more than one drug to obtain the desired improvement. There are fixed-dose combination drugs, such as ACE inhibitor and thiazide combinations. ACE inhibitors have also been used in chronic kidney failure and kidney involvement in systemic sclerosis (hardening of tissues, as scleroderma renal crisis). In those with stable coronary artery disease, but no heart failure, benefits are similar to other usual treatments. [9]

In 2012, a meta-analysis published in the BMJ described the protective role of ACE inhibitors in reducing the risk of pneumonia when compared to angiotensin II receptor blocker (ARBs). [10] The authors found a decreased risk in patients with previous stroke (54% risk reduction), with heart failure (37% risk reduction), and of Asian descent (43% risk reduction vs 54% risk reduction in non-Asian population). However, no reduced pneumonia-related mortality was observed. [11]

Other

ACE inhibitors may also be used to help decrease excessive water consumption in people with schizophrenia resulting in psychogenic polydipsia. [12] [13] A double-blind, placebo-controlled trial showed that when used for this purpose, enalapril led to decreased consumption (determined by urine output and osmolality) in 60% of people; [14] the same effect has been demonstrated in other ACE inhibitors. [15]

Additionally ACE-I are commonly used after renal transplant to manage post-transplant erythrocytosis, a condition characterised by a persistently high hematocrit greater than 51% which often develops 8–24 months after successful transplantation, [16] as ACE-I have been shown to decrease erythropoietin production. [17]

Adverse effects

Common side effects include: low blood pressure, cough, hyperkalemia, headache, dizziness, fatigue, nausea, and kidney impairment. [18] [19]

The main adverse effects of ACE inhibition can be understood from their pharmacological action. The other reported adverse effects are liver problems and effects on the fetus. [19] Kidney problems may occur with all ACE inhibitors that directly follows from their mechanism of action. Patients starting on an ACE inhibitor usually have a modest reduction in glomerular filtration rate (GFR). [20] However, the decrease may be significant in conditions of pre-existing decreased renal perfusions, such as renal artery stenosis, heart failure, polycystic kidney disease, or volume depletion. In these patients, the maintenance of GFR depends on angiotensin-II-dependent efferent vasomotor tone. [20] Therefore, renal function should be closely monitored over the first few days after initiation of treatment with ACE inhibitor in patients with decreased renal perfusion. [19] A moderate reduction in renal function, no greater than 30% rise in serum creatinine, that is stabilized after a week of treatment is deemed acceptable as part of the therapeutic effect, providing the residual renal function is sufficient.[ citation needed ]

Reduced GFR is especially a problem if the patient is concomitantly taking an NSAID and a diuretic. [21] When the three drugs are taken together, the risk of developing renal failure is significantly increased. [22]

High blood potassium is another possible complication of treatment with an ACE inhibitor due to its effect on aldosterone. Suppression of angiotensin II leads to a decrease in aldosterone levels. Since aldosterone is responsible for increasing the excretion of potassium, ACE inhibitors can cause retention of potassium. Some people, however, can continue to lose potassium while on an ACE inhibitor. [23] Hyperkalemia may decrease the velocity of impulse conduction in the nerves and muscles, including cardiac tissues. This leads to cardiac dysfunction and neuromuscular consequences, such as muscle weakness, paresthesia, nausea, diarrhea, and others. Close monitoring of potassium levels is required in patients receiving treatment with ACE inhibitors who are at risk of hyperkalemia. [19]

Another possible adverse effect specific for ACE inhibitors, but not for other RAAS blockers, is an increase in bradykinin level. [19]

A persistent dry cough is a relatively common adverse effect believed to be associated with the increases in bradykinin levels produced by ACE inhibitors, although the role of bradykinin in producing these symptoms has been disputed. [24] Many cases of cough in people on ACE inhibitors may not be from the medication itself, however. [25] People who experience this cough are often switched to angiotensin II receptor antagonists.[ citation needed ]

Some (0.7%) [21] develop angioedema due to increased bradykinin levels. [26] A genetic predisposition may exist. [27]

A severe rare allergic reaction can affect the bowel wall and secondarily cause abdominal pain. [28]

Blood

Hematologic effects, such as neutropenia, agranulocytosis and other blood dyscrasias, have occurred during therapy with ACE inhibitors, especially in people with additional risk factors. [29]

Pregnancy

In pregnant women, ACE inhibitors taken during all the trimesters have been reported to cause congenital malformations, stillbirths, and neonatal deaths. Commonly reported fetal abnormalities include hypotension, renal dysplasia, anuria/oliguria, oligohydramnios, intrauterine growth retardation, pulmonary hypoplasia, patent ductus arteriosus, and incomplete ossification of the skull. [19] [30] Overall, about half of newborns exposed to ACE inhibitors are adversely affected, leading to birth defects. [31] [21]

ACE inhibitors are ADEC pregnancy category D and should be avoided in women who are likely to become pregnant. [18] In the U.S., ACE inhibitors must be labeled with a boxed warning concerning the risk of birth defects when taken during the second and third trimester. Their use in the first trimester is also associated with a risk of major congenital malformations, particularly affecting the cardiovascular and central nervous systems. [32]

Overdose

Symptoms and Treatment: There are few reports of ACE inhibitor overdose in the literature. The most likely manifestations are hypotension, which may be severe, hyperkalemia, hyponatremia and renal impairment with metabolic acidosis. Treatment should be mainly symptomatic and supportive, with volume expansion using normal saline to correct hypotension and improve renal function, and gastric lavage followed by activated charcoal and a cathartic to prevent further absorption of the drug. Captopril, enalapril, lisinopril and perindopril are known to be removable by hemodialysis. [33]

Contraindications and precautions

The ACE inhibitors are contraindicated in people with:[ citation needed ]

ACE inhibitors should be used with caution in people with:[ citation needed ]

A combination of ACE inhibitor with other drugs may increase effects of these drugs, but also the risk of adverse effects. [19] The commonly reported adverse effects of drug combination with ACE inhibitor are acute renal failure, hypotension, and hyperkalemia. The drugs interacting with ACE inhibitor should be prescribed with caution. Special attention should be given to combinations of ACE inhibitor with other RAAS blockers, diuretics (especially potassium-sparing diuretics), NSAIDs, anticoagulants, cyclosporine, DPP-4 inhibitors, and potassium supplements.

Potassium supplementation should be used with caution and under medical supervision owing to the hyperkalemic effect of ACE inhibitors. [36]

Concomitant use with cyclooxygenase inhibitors tends to decrease ACE inhibitor's hypotensive effect. [37] [21]

Mechanism of action

ACE inhibitors reduce the activity of the renin–angiotensin–aldosterone system (RAAS) as the primary etiologic (causal) event in the development of hypertension in people with diabetes mellitus, as part of the insulin-resistance syndrome or as a manifestation of renal disease. [38] [39]

Renin–angiotensin–aldosterone system

Renin-angiotensin-aldosterone system Renin-angiotensin-aldosterone system.svg
Renin–angiotensin–aldosterone system

The renin–angiotensin–aldosterone system is a major blood pressure regulating mechanism. Markers of electrolyte and water imbalance in the body such as hypotension, low distal tubule sodium concentration, decreased blood volume and high sympathetic tone trigger the release of the enzyme renin from the cells of juxtaglomerular apparatus in the kidney.[ citation needed ]

Renin activates a circulating liver derived prohormone angiotensinogen by proteolytic cleavage of all but its first ten amino acid residues known as angiotensin I. ACE (angiotensin converting enzyme) then removes a further two residues, converting angiotensin I into angiotensin II. ACE is found in the pulmonary circulation and in the endothelium of many blood vessels. [40] The system increases blood pressure by increasing the amount of salt and water the body retains, although angiotensin II is also a potent vasoconstrictor. [41]

Effects

ACE inhibitors block the conversion of angiotensin I (ATI) to angiotensin II (ATII). [42] They thereby lower arteriolar resistance and increase venous capacity; decrease cardiac output, cardiac index, stroke work, and volume; lower resistance in blood vessels in the kidneys; and lead to increased natriuresis (excretion of sodium in the urine). Renin increases in concentration in the blood as a result of negative feedback of conversion of ATI to ATII. ATI increases for the same reason; ATII and aldosterone decrease. Bradykinin increases because of less inactivation by ACE.[ citation needed ]

Under normal conditions, angiotensin II has these effects:

During the course of ACE inhibitor use, the production of ATII is decreased, [note 1] [43] which prevents aldosterone release from the adrenal cortex. [43] This allows the kidney to excrete sodium ions along with obligate water, and retain potassium ions. This decreases blood volume, leading to decreased blood pressure. [43]

Epidemiological and clinical studies have shown ACE inhibitors reduce the progress of diabetic nephropathy independently from their blood pressure-lowering effect. [44] This action of ACE inhibitors is used in the prevention of diabetic renal failure.[ citation needed ]

ACE inhibitors have been shown to be effective for indications other than hypertension [45] even in patients with normal blood pressure. [46] The use of a maximum dose of ACE inhibitors in such patients (including for prevention of diabetic nephropathy, congestive heart failure, and prophylaxis of cardiovascular events) is justified, [47] because it improves clinical outcomes independently of the blood pressure-lowering effect of ACE inhibitors. Such therapy, of course, requires careful and gradual titration of the dose to prevent the effects of rapidly decreasing blood pressure (dizziness, fainting, etc.).[ citation needed ]

ACE inhibitors have also been shown to cause a central enhancement of parasympathetic nervous system activity in healthy volunteers and patients with heart failure. [48] [49] This action may reduce the prevalence of malignant cardiac arrhythmias, and the reduction in sudden death reported in large clinical trials. [50] ACE Inhibitors also reduce plasma norepinephrine levels, and its resulting vasoconstriction effects, in heart failure patients, thus breaking the vicious circles of sympathetic and renin angiotensin system activation, which sustains the downward spiral in cardiac function in congestive heart failure[ citation needed ]

The ACE inhibitor enalapril has also been shown to reduce cardiac cachexia in patients with chronic heart failure. [51] Cachexia is a poor prognostic sign in patients with chronic heart failure. [52] ACE inhibitors are under early investigation for the treatment of frailty and muscle wasting (sarcopenia) in elderly patients without heart failure. [53]

Examples

Currently, there are 10 ACE inhibitors approved for use in the United States by the FDA: captopril (1981), enalapril (1985), lisinopril (1987), benazepril (1991), fosinopril (1991), quinapril (1991), ramipril (1991), perindopril (1993), moexipril (1995) and trandolapril (1996). [54] [55]

ACE inhibitors are easily identifiable by their common suffix, '-pril'. ACE inhibitors can be divided into three groups based on their molecular structure of the enzyme binding sites (sulfhydryl, phosphinyl, carboxyl) to the active center of ACE: [56]

Sulfhydryl-containing agents

These agents appear to show antioxidative properties but may be involved in adverse events such as skin eruptions. [56]

Dicarboxylate-containing agents

This is the largest group, including:[ citation needed ]

Phosphonate-containing agents

Naturally occurring

Dairy products

Comparative information

All ACE inhibitors have similar antihypertensive efficacy when equivalent doses are administered. The main differences lie with captopril, the first ACE inhibitor. Captopril has a shorter duration of action and an increased incidence of adverse effects. It is also the only ACE inhibitor capable of passing through the blood–brain barrier, although the significance of this characteristic has not been shown to have any positive clinical effects.[ citation needed ]

In a large clinical study, one of the agents in the ACE inhibitor class, ramipril (Altace), demonstrated an ability to reduce the mortality rates of patients with a myocardial infarction and to slow the subsequent development of heart failure. This finding was made after it was discovered that regular use of ramipril reduced mortality rates even in test subjects who did not have hypertension. [63]

Some believe ramipril's additional benefits may be shared by some or all drugs in the ACE-inhibitor class. However, ramipril currently remains the only ACE inhibitor for which such effects are actually evidence-based. [64]

A meta-analysis confirmed that ACE inhibitors are effective and certainly the first-line choice in hypertension treatment. This meta-analysis was based on 20 trials and a cohort of 158,998 patients, of whom 91% were hypertensive. ACE inhibitors were used as the active treatment in seven trials (n=76,615) and angiotensin receptor blocker (ARB) in 13 trials (n=82,383). ACE inhibitors were associated with a statistically significant 10% mortality reduction: (HR 0.90; 95% CI, 0.84–0.97; P=0.004). In contrast, no significant mortality reduction was observed with ARB treatment (HR 0.99; 95% CI, 0.94–1.04; P=0.683). Analysis of mortality reduction by different ACE inhibitors showed that perindopril-based regimens are associated with a statistically significant 13% all-cause mortality reduction. Taking into account the broad spectrum of the hypertensive population, one might expect that an effective treatment with ACE inhibitors, in particular with perindopril, would result in an important gain of lives saved. [65]

Equivalent doses in hypertension

The ACE inhibitors have different strengths with different starting dosages. Dosage should be adjusted according to the clinical response. [66] [67] [68]

ACE inhibitors dosages for hypertension
Dosage
Note: bid = two times a day, tid = three times a day, d = daily
Drug dosages from Drug Lookup, Epocrates Online.
NameEquivalent daily doseStartUsualMaximum
Benazepril10 mg10 mg20–40 mg80 mg
Captopril50 mg (25 mg bid)12.5–25 mg bid-tid25–50 mg bid-tid150 mg/d
Enalapril5 mg5 mg10–40 mg40 mg
Fosinopril10 mg10 mg20–40 mg80 mg
Lisinopril10 mg10 mg10–40 mg80 mg
Moexipril7.5 mg7.5 mg7.5–30 mg30 mg
Perindopril4 mg4 mg4–8 mg16 mg
Quinapril10 mg10 mg20–80 mg80 mg
Ramipril2.5 mg2.5 mg2.5–20 mg20 mg
Trandolapril2 mg1 mg2–4 mg8 mg

Combination with angiotensin II receptor antagonists

ACE inhibitors possess many common characteristics with another class of cardiovascular drugs, angiotensin II receptor antagonists, which are often used when patients are intolerant of the adverse effects produced by ACE inhibitors. ACE inhibitors do not completely prevent the formation of angiotensin II, as blockage is dose-dependent, so angiotensin II receptor antagonists may be useful because they act to prevent the action of angiotensin II at the AT1 receptor, leaving AT2 receptor unblocked; the latter may have consequences needing further study.[ citation needed ]

The combination therapy of angiotensin II receptor antagonists with ACE inhibitors may be superior to either agent alone. This combination may increase levels of bradykinin while blocking the generation of angiotensin II and its activity at the AT1 receptor. This 'dual blockade' may be more effective than using an ACE inhibitor alone, because angiotensin II can be generated via non-ACE-dependent pathways. Preliminary studies suggest this combination of pharmacologic agents may be advantageous in the treatment of essential hypertension, chronic heart failure, [69] and nephropathy. [70] [71] However, the more recent ONTARGET study showed no benefit of combining the agents and more adverse events. [72] While statistically significant results have been obtained for its role in treating hypertension, clinical significance may be lacking. [73] There are warnings about the combination of ACE inhibitors with ARBs. [74]

Patients with heart failure may benefit from the combination in terms of reducing morbidity and ventricular remodeling. [75] [76]

The most compelling evidence for the treatment of nephropathy has been found: This combination therapy partially reversed the proteinuria and also exhibited a renoprotective effect in patients with diabetic nephropathy, [70] and pediatric IgA nephropathy. [77]

History

Leonard T. Skeggs and his colleagues (including Norman Shumway) discovered ACE in plasma in 1956. [78] It was also noted that those who worked in banana plantations in South-western Brazil collapsed after being bitten by a pit viper, leading to a search for a blood pressure lowering component in its venom. [79] Brazilian scientist Sérgio Henrique Ferreira reported a bradykinin-potentiating factor (BPF) present in the venom of Bothrops jararaca , a South American pit viper, in 1965. [80] Ferreira then went to John Vane's laboratory as a postdoctoral fellow with his already-isolated BPF. The conversion of the inactive angiotensin I to the potent angiotensin II was thought to take place in the plasma. However, in 1967, Kevin K. F. Ng and John R. Vane showed plasma ACE is too slow to account for the conversion of angiotensin I to angiotensin II in vivo. Subsequent investigation showed rapid conversion occurs during its passage through the pulmonary circulation. [81]

Bradykinin is rapidly inactivated in the circulating blood, and it disappears completely in a single pass through the pulmonary circulation. Angiotensin I also disappears in the pulmonary circulation because of its conversion to angiotensin II. Furthermore, angiotensin II passes through the lungs without any loss. The inactivation of bradykinin and the conversion of angiotensin I to angiotensin II in the lungs was thought to be caused by the same enzyme. [82] In 1970, Ng and Vane, using BPF provided by Ferreira, showed the conversion is inhibited during its passage through the pulmonary circulation. [83]

BPFs are members of a family of peptides whose potentiating action is linked to inhibition of bradykinin by ACE. Molecular analysis of BPF yielded a nonapeptide BPF teprotide (SQ 20,881), which showed the greatest ACE inhibition potency and hypotensive effect in vivo. Teprotide had limited clinical value as a result of its peptide nature and lack of activity when given orally. In the early 1970s, knowledge of the structure-activity relationship required for inhibition of ACE was growing. David Cushman, Miguel Ondetti and colleagues used peptide analogues to study the structure of ACE, using carboxypeptidase A as a model. Their discoveries led to the development of captopril, the first orally-active ACE inhibitor, in 1975. [84]

Captopril was approved by the United States Food and Drug Administration in 1981. [85] The first nonsulfhydryl-containing ACE inhibitor, enalapril, was approved four years later. [86] At least 8 other ACE inhibitors have since been marketed. [87]

In 1991, Japanese scientists created the first milk-based ACE inhibitor, in the form of a fermented milk drink, using specific cultures to liberate the tripeptide isoleucine-proline-proline (IPP) from the dairy protein. Valine-proline-proline (VPP) is also liberated in this process—another milk tripeptide with a very similar chemical structure to IPP. Together, these peptides are now often referred to as lactotripeptides. In 1996, the first human study confirmed the blood pressure-lowering effect of IPP in fermented milk. [88] Although twice the amount of VPP is needed to achieve the same ACE-inhibiting activity as the originally discovered IPP, VPP also is assumed to add to the total blood pressure lowering effect. [89] Since the first lactotripeptides discovery, more than 20 human clinical trials have been conducted in many different countries. [61]

Note

  1. ↑ ACE inhibitors don't appear to permanently reduce ATII plasma level after cessation of taking it. In short, ACE inhibitors don't cure high ATII plasma levels. [43]

See also

Related Research Articles

<span class="mw-page-title-main">Renin</span> Aspartic protease protein and enzyme

Renin, also known as an angiotensinogenase, is an aspartic protease protein and enzyme secreted by the kidneys that participates in the body's renin-angiotensin-aldosterone system (RAAS)—also known as the renin-angiotensin-aldosterone axis—that increases the volume of extracellular fluid and causes arterial vasoconstriction. Thus, it increases the body's mean arterial blood pressure.

<span class="mw-page-title-main">Renin–angiotensin system</span> Hormone system

The renin-angiotensin system (RAS), or renin-angiotensin-aldosterone system (RAAS), is a hormone system that regulates blood pressure, fluid, and electrolyte balance, and systemic vascular resistance.

<span class="mw-page-title-main">Angiotensin</span> Group of peptide hormones in mammals

Angiotensin is a peptide hormone that causes vasoconstriction and an increase in blood pressure. It is part of the renin–angiotensin system, which regulates blood pressure. Angiotensin also stimulates the release of aldosterone from the adrenal cortex to promote sodium retention by the kidneys.

<span class="mw-page-title-main">Captopril</span> Antihypertensive drug of the ACE inhibitor class

Captopril, sold under the brand name Capoten among others, is an angiotensin-converting enzyme (ACE) inhibitor used for the treatment of hypertension and some types of congestive heart failure. Captopril was the first oral ACE inhibitor found for the treatment of hypertension. It does not cause fatigue as associated with beta-blockers. Due to the adverse drug event of causing hyperkalemia, as seen with most ACE Inhibitors, the medication is usually paired with a diuretic.

Antihypertensives are a class of drugs that are used to treat hypertension. Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke, heart failure, kidney failure and myocardial infarction. Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34% and of ischaemic heart disease by 21%, and can reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease. There are many classes of antihypertensives, which lower blood pressure by different means. Among the most important and most widely used medications are thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists (ARBs), and beta blockers.

<span class="mw-page-title-main">Angiotensin-converting enzyme</span> Mammalian protein found in humans

Angiotensin-converting enzyme, or ACE, is a central component of the renin–angiotensin system (RAS), which controls blood pressure by regulating the volume of fluids in the body. It converts the hormone angiotensin I to the active vasoconstrictor angiotensin II. Therefore, ACE indirectly increases blood pressure by causing blood vessels to constrict. ACE inhibitors are widely used as pharmaceutical drugs for treatment of cardiovascular diseases.

<span class="mw-page-title-main">Enalapril</span> ACE inhibitor medication

Enalapril, sold under the brand name Vasotec among others, is an ACE inhibitor medication used to treat high blood pressure, diabetic kidney disease, and heart failure. For heart failure, it is generally used with a diuretic, such as furosemide. It is given by mouth or by injection into a vein. Onset of effects are typically within an hour when taken by mouth and last for up to a day.

<span class="mw-page-title-main">Fosinopril</span> Antihypertensive drug of the ACE inhibitor class

Fosinopril is an angiotensin converting enzyme (ACE) inhibitor used for the treatment of hypertension and some types of chronic heart failure. Fosinopril is the only phosphonate-containing ACE inhibitor marketed, by Bristol-Myers Squibb under the trade name Monopril. Fosinopril is a cascading pro-drug. The special niche for the medication that differentiates it from the other members of the ACE Inhibitor drug class is that was specifically developed for the use for patients with renal impairment. This was through manipulation of the metabolism and excretion, and is seen that fifty percent of the drug is hepatobiliary cleared, which can compensate for diminished renal clearance. The remaining fifty percent is excreted in urine. It does not need dose adjustment.

<span class="mw-page-title-main">Angiotensin II receptor blocker</span> Group of pharmaceuticals that modulate the renin–angiotensin system

Angiotensin II receptor blockers (ARBs), formally angiotensin II receptor type 1 (AT1) antagonists, also known as angiotensin receptor blockers, angiotensin II receptor antagonists, or AT1 receptor antagonists, are a group of pharmaceuticals that bind to and inhibit the angiotensin II receptor type 1 (AT1) and thereby block the arteriolar contraction and sodium retention effects of renin–angiotensin system.

<span class="mw-page-title-main">Renal artery stenosis</span> Kidney disease

Renal artery stenosis (RAS) is the narrowing of one or both of the renal arteries, most often caused by atherosclerosis or fibromuscular dysplasia. This narrowing of the renal artery can impede blood flow to the target kidney, resulting in renovascular hypertension – a secondary type of high blood pressure. Possible complications of renal artery stenosis are chronic kidney disease and coronary artery disease.

<span class="mw-page-title-main">Lisinopril</span> Medication used to treat hypertension and heart failure

Lisinopril is a medication belonging to the drug class of angiotensin-converting enzyme (ACE) inhibitors and is used to treat hypertension, heart failure, and heart attacks. For high blood pressure it is usually a first-line treatment. It is also used to prevent kidney problems in people with diabetes mellitus. Lisinopril is taken orally. Full effect may take up to four weeks to occur.

<span class="mw-page-title-main">Ramipril</span> ACE inhibitor medication

Ramipril, sold under the brand name Altace among others, is an ACE inhibitor type medication used to treat high blood pressure, heart failure, and diabetic kidney disease. It can also be used as a preventative medication in patients over 55 years old to reduce the risk of having a heart attack, stroke or cardiovascular death in patients shown to be at high risk, such as some diabetics and patients with vascular disease. It is a reasonable initial treatment for high blood pressure. It is taken by mouth.

<span class="mw-page-title-main">Quinapril</span> ACE inhibitor used in the treatment of hypertension and congestive heart failure

Quinapril, sold under the brand name Accupril by the Pfizer corporation. It a medication used to treat high blood pressure (hypertension), heart failure, and diabetic kidney disease. It is a first line treatment for high blood pressure. It is taken by mouth.

<span class="mw-page-title-main">Valsartan</span> Angiotensin II receptor antagonist

Valsartan, sold under the brand name Diovan among others, is a medication used to treat high blood pressure, heart failure, and diabetic kidney disease. It belongs to a class of medications referred to as angiotensin II receptor blockers (ARBs). It is a reasonable initial treatment for high blood pressure. It is taken by mouth.

<span class="mw-page-title-main">Perindopril</span> High blood pressure medication

Perindopril is a medication used to treat high blood pressure, heart failure, or stable coronary artery disease.

<span class="mw-page-title-main">Aliskiren</span> Medication

Aliskiren is the first in a class of drugs called direct renin inhibitors. It is used for essential (primary) hypertension. While used for high blood pressure, other better studied medications are typically recommended due to concerns of higher side effects and less evidence of benefit.

<span class="mw-page-title-main">Renin inhibitor</span> Compound inhibiting the activity of renin

Renin inhibitors are pharmaceutical drugs inhibiting the activity of renin that is responsible for hydrolyzing angiotensinogen to angiotensin I, which in turn reduces the formation of angiotensin II that facilitates blood pressure.

<span class="mw-page-title-main">Moexipril</span> Antihypertensive drug of the ACE inhibitor class

Moexipril was an angiotensin converting enzyme inhibitor used for the treatment of hypertension and congestive heart failure. Moexipril can be administered alone or with other antihypertensives or diuretics.

<span class="mw-page-title-main">Sacubitril/valsartan</span> Combination medication

Sacubitril/valsartan, sold under the brand name Entresto among others, is a fixed-dose combination medication for use in heart failure. It consists of the neprilysin inhibitor sacubitril and the angiotensin receptor blocker valsartan. The combination is sometimes described as an "angiotensin receptor-neprilysin inhibitor" (ARNi). In 2016, the American College of Cardiology/American Heart Association Task Force recommended it as a replacement for an ACE inhibitor or an angiotensin receptor blocker in people with heart failure with reduced ejection fraction.

<span class="mw-page-title-main">Fimasartan</span> Chemical compound

Fimasartan is a non-peptide angiotensin II receptor antagonist (ARB) used for the treatment of hypertension and heart failure. Through oral administration, fimasartan blocks angiotensin II receptor type 1 (AT1 receptors), reducing pro-hypertensive actions of angiotensin II, such as systemic vasoconstriction and water retention by the kidneys. Concurrent administration of fimasartan with diuretic hydrochlorothiazide has shown to be safe in clinical trials. Fimasartan was approved for use in South Korea on September 9, 2010, and is available under the brand name Kanarb through Boryung Pharmaceuticals, who are presently seeking worldwide partnership.

References

  1. 1 2 3 4 Kaplan's Essentials of Cardiac Anesthesia. Elsevier. 2018. doi:10.1016/c2012-0-06151-0. ISBN   978-0-323-49798-5. Mechanisms of Action:ACE inhibitors act by inhibiting one of several proteases responsible for cleaving the decapeptide Ang I to form the octapeptide Ang II. Because ACE is also the enzyme that degrades bradykinin, ACE inhibitors increase circulating and tissue levels of bradykinin (Fig. 8.4).
  2. ↑ Aronow WS (2010). "Cardiac Arrhythmias". Brocklehurst's Textbook of Geriatric Medicine and Gerontology. Elsevier. pp. 327–337. doi:10.1016/b978-1-4160-6231-8.10045-5. ISBN   978-1-4160-6231-8. Angiotensin-converting enzyme inhibitors ACE inhibitors have been demonstrated to reduce sudden cardiac death in some studies of persons with CHF.24,56
  3. 1 2 3 Byrd JB, Ram CV, Lerma EV (2019). "Pharmacologic treatment of hypertension". Nephrology Secrets. Elsevier. pp. 477–482. doi:10.1016/b978-0-323-47871-7.00078-2. ISBN   978-0-323-47871-7. S2CID   263490929. ACE inhibitors inhibit the conversion of angiotensin I to angiotensin II, thereby producing vasodilation and lowering BP. Because the hydrolysis of bradykinin is also inhibited by these drugs, cough (7% to 12%) can occur.
  4. ↑ Jackson EK (2006). "Chapter 30. Renin and Angiotensin". In Brunton LL, Lazo JS, Parker K (eds.). Goodman & Gilman's The Pharmacological Basis of Therapeutics (11th ed.). New York: McGraw-Hill. ISBN   978-0-07-142280-2.
  5. ↑ "Myocardial Infarction". The Lecturio Medical Concept Library. Retrieved 27 August 2021.
  6. ↑ "Congestive Heart Failure". The Lecturio Medical Concept Library. 7 August 2020. Retrieved 27 August 2021.
  7. ↑ Kester M, Karpa KD, Vrana KE (2012). "Cardiovascular System". Elsevier's Integrated Review Pharmacology. Elsevier. pp. 125–151. doi:10.1016/b978-0-323-07445-2.00008-2. ISBN   978-0-323-07445-2. ACE inhibitors also slow progression of kidney disease in patients with diabetic nephropathies. Renal benefits are probably a result of improved renal hemodynamics from decreased glomerular arteriolar resistance.
  8. ↑ "Type 2 diabetes in adults: management". www.nice.org.uk. National Institute for Health and Care Excellence (NICE). May 2017. Retrieved October 25, 2018.
  9. ↑ Bangalore S, Fakheri R, Wandel S, Toklu B, Wandel J, Messerli FH (19 January 2017). "Renin angiotensin system inhibitors for patients with stable coronary artery disease without heart failure: systematic review and meta-analysis of randomized trials". BMJ (Clinical Research Ed.). 356: j4. doi:10.1136/bmj.j4. PMC   5244819 . PMID   28104622.
  10. ↑ Caldeira D, Alarcao J, Vaz-Carneiro A, Costa J (2012-07-11). "Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis". The BMJ. 345 (jul11 1). BMJ: e4260. doi:10.1136/bmj.e4260. ISSN   1756-1833. PMC   3394697 . PMID   22786934.
  11. ↑ Caldeira D (Summer 2012). "Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis". BMJ. 345: 4260. doi:10.1136/bmj.e4260. PMC   3394697 . PMID   22786934.
  12. ↑ "Psychogenic polydipsia – Management – Emerging treatments". British Medical Journal. May 5, 2016. Archived from the original on August 27, 2021. Retrieved October 28, 2016.
  13. ↑ Dundas B, Harris M, Narasimhan M (2007-07-03). "Psychogenic polydipsia review: Etiology, differential, and treatment". Current Psychiatry Reports. 9 (3): 236–241. doi:10.1007/s11920-007-0025-7. ISSN   1523-3812. PMID   17521521. S2CID   27207760.
  14. ↑ Greendyke RM, Bernhardt AJ, Tasbas HE, Lewandowski KS (1998-04-01). "Polydipsia in chronic psychiatric patients: therapeutic trials of clonidine and enalapril". Neuropsychopharmacology. 18 (4): 272–281. doi: 10.1016/S0893-133X(97)00159-0 . ISSN   0893-133X. PMID   9509495.
  15. ↑ Sebastian CS, Bernardin AS (1990-04-01). "Comparison of enalapril and captopril in the management of self-induced water intoxication". Biological Psychiatry. 27 (7): 787–790. doi:10.1016/0006-3223(90)90594-r. ISSN   0006-3223. PMID   2183881. S2CID   39998447.
  16. ↑ Vlahakos DV, Marathias KP, Agroyannis B, Madias NE (2003-04-01). "Posttransplant erythrocytosis". Kidney International. 63 (4): 1187–1194. doi: 10.1046/j.1523-1755.2003.00850.x . ISSN   0085-2538. PMID   12631334.
  17. ↑ Cruzado JM, Rico J, Grinyó JM (April 2008). "The renin angiotensin system blockade in kidney transplantation: pros and cons". Transplant International. 21 (4): 304–313. doi:10.1111/j.1432-2277.2008.00638.x. PMID   18266774. S2CID   24893488.
  18. 1 2 Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN   0-9757919-2-3.[ page needed ]
  19. 1 2 3 4 5 6 7 Sidorenkov G, Navis G (2014). "Safety of ACE inhibitor therapies in patients with chronic kidney disease". Expert Opinion on Drug Safety. 13 (10): 1383–1395. doi:10.1517/14740338.2014.951328. PMID   25148900. S2CID   207488068.
  20. 1 2 Tucker BM, Perazella MA (2019). "Medications: 3. What are the major adverse effects on the kidney of ACE inhibitors and ARBs?". Nephrology Secrets. Elsevier. pp. 78–83. doi:10.1016/b978-0-323-47871-7.00019-8. ISBN   978-0-323-47871-7. S2CID   239423283. due to inhibition of angiotensin II production by ACE inhibitors or competitive antagonism of the angiotensin II receptor by ARBs... results in loss of angiotensin II–induced efferent arteriolar tone, leading to a drop in glomerular filtration fraction and GFR. The efferent arteriolal vasodilation reduces intraglomerular hypertension (and pressure-related injury) and maintains perfusion (and oxygenation) of the peritubular capillaries.
  21. 1 2 3 4 Byrd JB, Ram CV, Lerma EV (2019). "Pharmacologic treatment of hypertension". Nephrology Secrets. Elsevier. pp. 477–482. doi:10.1016/b978-0-323-47871-7.00078-2. ISBN   978-0-323-47871-7. S2CID   263490929. Angioedema (0.7%) can also occur via pathobiology that remains obscure, and its occurrence can be life-threatening. ...their efficacy is reduced by dietary or other sources of sodium, and renal function may be further threatened if given with NSAIDs.
  22. ↑ Thomas MC (2000). "Diuretics, ACE inhibitors and NSAIDs—the triple whammy". The Medical Journal of Australia. 172 (4): 184–5. doi:10.5694/j.1326-5377.2000.tb125548.x. PMID   10772593. S2CID   37558579.
  23. ↑ Cohn JN, Kowey PR, Whelton PK, Prisant LM (2000). "New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice". Archives of Internal Medicine. 160 (16): 2429–36. doi: 10.1001/archinte.160.16.2429 . PMID   10979053.
  24. ↑ Okumura H, Nishimura E, Kariya S, OHTANI M, UCHINO K, FUKATSU T, et al. (1 March 2001). "No Relation between Angiotensin-Converting Enzyme (ACE) Inhibitor-Induced Cough and ACE Gene Polymorphism, Plasma Bradykinin, Substance P and ACE Inhibitor Concentration in Japanese Patients". Yakugaku Zasshi. 121 (3): 253–257. doi: 10.1248/yakushi.121.253 . PMID   11265121.
  25. ↑ Vukadinović D, Vukadinović AN, Lavall D, Laufs U, Wagenpfeil S, Böhm M (March 2019). "Rate of Cough During Treatment With Angiotensin-Converting Enzyme Inhibitors: A Meta-Analysis of Randomized Placebo-Controlled Trials". Clinical Pharmacology and Therapeutics. 105 (3): 652–660. doi:10.1002/cpt.1018. PMID   29330882. S2CID   46779755.
  26. ↑ Bezalel S, Mahlab-Guri K, Asher I, Werner B, Sthoeger ZM (February 2015). "Angiotensin-converting enzyme inhibitor-induced angioedema". The American Journal of Medicine. 128 (2): 120–5. doi:10.1016/j.amjmed.2014.07.011. PMID   25058867.
  27. ↑ Molinaro G, Cugno M, Perez M, Lepage Y, Gervais N, Agostoni A, et al. (2002). "Angiotensin-converting enzyme inhibitor-associated angioedema is characterized by a slower degradation of des-arginine(9)-bradykinin" (PDF). The Journal of Pharmacology and Experimental Therapeutics. 303 (1): 232–7. doi:10.1124/jpet.102.038067. hdl:2434/161106. PMID   12235256. S2CID   13866090.
  28. ↑ Augenstein VA, Heniford BT, Sing RF (March 2013). "Intestinal angioedema induced by angiotensin-converting enzyme inhibitors: an underrecognized cause of abdominal pain?". The Journal of the American Osteopathic Association. 113 (3): 221–3. PMID   23485983.
  29. ↑ FDA Prescribing information, http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20%28General%20Monographs-%20A%29/ACE%20INHIBITORS.html
  30. ↑ Sørensen AM, Christensen S, Jonassen TE, Andersen D, Petersen JS (March 1998). "[Teratogenic effects of ACE-inhibitors and angiotensin II receptor antagonists]". Ugeskrift for Laeger (in Danish). 160 (10): 1460–4. PMID   9520613.
  31. ↑ Bullo M, Tschumi S, Bucher BS, Bianchetti MG, Simonetti GD (2012). "Pregnancy Outcome Following Exposure to Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Antagonists: A Systematic Review". Hypertension. 60 (2): 444–50. doi: 10.1161/HYPERTENSIONAHA.112.196352 . PMID   22753220.
  32. ↑ Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, Gideon PS, et al. (2006). "Major congenital malformations after first-trimester exposure to ACE inhibitors". The New England Journal of Medicine. 354 (23): 2443–2451. doi: 10.1056/NEJMoa055202 . PMID   16760444.
  33. ↑ "ACE Inhibitors". RxMed.com. Retrieved 2018-09-20.
  34. ↑ "ACE I". cvpharmacology.
  35. 1 2 "ACEI contraindications". Open Anesthesia.
  36. ↑ Bakris GL, Siomos M, Richardson D, Janssen I, Bolton WK, Hebert L, et al. (November 2000). "ACE inhibition or angiotensin receptor blockade: impact on potassium in renal failure. VAL-K Study Group". Kidney International. 58 (5): 2084–92. doi: 10.1111/j.1523-1755.2000.00381.x . PMID   11044229.
  37. ↑ Sear JW (2019). "Antihypertensive Drugs and Vasodilators". Pharmacology and Physiology for Anesthesia. Elsevier. pp. 535–555. doi:10.1016/b978-0-323-48110-6.00026-0. ISBN   978-0-323-48110-6. S2CID   220688413. Coadministration of nonsteroidal anti-inflammatory drugs (NSAIDs [cyclooxygenase inhibitors]) can reduce the hypotensive effects of ACE inhibitors. ACE inhibitors can inhibit the excretion of lithium and can result in lithium toxicity. Because these drugs do not affect the breakdown of kinins (as is seen with the ACE inhibitors), patients do not develop episodes of coughing and rarely develop angioneurotic edema.
  38. ↑ Jandeleit-Dahm K, Cooper ME (Sep 2006). "Hypertension and diabetes: role of the renin–angiotensin system". Endocrinol Metab Clin North Am. 35 (3): 469–90, vii. doi:10.1016/j.ecl.2006.06.007. PMID   16959581.
  39. ↑ Wang W, McKinnie SM, Farhan M, Paul M, McDonald T, McLean B, et al. (May 2016). "Angiotensin Converting Enzyme 2 Metabolizes and Partially Inactivates Pyrapelin-13 and Apelin-17: Physiological Effects in the Cardiovascular System". Hypertension. 68 (2): 365–77. doi: 10.1161/HYPERTENSIONAHA.115.06892 . PMID   27217402. S2CID   829514.
  40. ↑ Human Physiology, Silverthorn (Pearson Benjamin Cummings 2004)[ page needed ]
  41. ↑ Weir M (1999). "The renin-angiotensin-aldosterone system: a specific target for hypertension management". American Journal of Hypertension. 12 (4). Oxford University Press (OUP): 205–213. doi:10.1016/s0895-7061(99)00103-x. ISSN   0895-7061. PMID   10619573.
  42. ↑ Ogbru O. "ACE Inhibitors (Angiotensin Converting Enzyme Inhibitors)". MedicineNet.com. MedicineNet, Inc. Archived from the original on 26 March 2010. Retrieved 2010-03-20.
  43. 1 2 3 4 Gradman AH, Traub D (2007). "Angiotensin-Converting Enzyme Inhibitors". Comprehensive Hypertension. Elsevier. pp. 985–1001. doi:10.1016/b978-0-323-03961-1.50083-0. ISBN   978-0-323-03961-1. Despite the lack of long-term suppression in plasma angiotensin II levels, they maintain their BP-lowering effect without the development of tolerance. Importantly, ACE inhibitors do not interfere with cognitive function or cardiovascular reflexes.
  44. ↑ Hoogwerf BJ, Young JB (2000). "The HOPE study. Ramipril lowered cardiovascular risk, but vitamin E did not". Cleveland Clinic Journal of Medicine. 67 (4): 287–93. doi:10.3949/ccjm.67.4.287. PMID   10780101.
  45. ↑ Bicket DP (August 2002). "Using ACE Inhibitors Appropriately". American Family Physician. 66 (3): 461–469. PMID   12182524 . Retrieved 20 February 2019.
  46. ↑ Jerums G, Allen TJ, Campbell DJ, Cooper ME, Gilbert RE, Hammond JJ, et al. (November 2004). "Long-term renoprotection by perindopril or nifedipine in non-hypertensive patients with Type 2 diabetes and microalbuminuria". Diabetic Medicine. 21 (11): 1192–1199. doi:10.1111/j.1464-5491.2004.01316.x. ISSN   0742-3071. PMID   15498085. S2CID   12855742.
  47. ↑ Strippoli GF, Craig M, Deeks JJ, Schena FP, Craig JC (2004-10-07). "Effects of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists on mortality and renal outcomes in diabetic nephropathy: systematic review". BMJ. 329 (7470): 828. doi:10.1136/bmj.38237.585000.7C. ISSN   0959-8138. PMC   521570 . PMID   15459003.
  48. ↑ Ajayi AA, Campbell BC, Howie CA, Reid JL (1985). "Acute and Chronic Effects of the Converting Enzyme Inhibitors Enalapril and Lisinopril on Reflex Control of Heart Rate in Normotensive Man". Journal of Hypertension. 3 (1): 47–53. doi:10.1097/00004872-198502000-00008. PMID   2987341.
  49. ↑ Adigun AQ, Asiyanbola B, Ajayi AA (2001). "Cardiac autonomic function in Blacks with congestive heart failure: vagomimetic action, alteration in sympathovagal balance, and the effect of ACE inhibition on central and peripheral vagal tone". Cell Mol Biol (Noisy le Grande). 47 (6): 1063–7. PMID   11785658.[ verification needed ]
  50. ↑ Binkley PF, Haas GJ, Starling RC, Nunziata E, Hatton PA, Leier CV, et al. (1 Mar 1993). "Sustained augmentation of parasympathetic tone with angiotensin-converting enzyme inhibition in patients with congestive heart failure". J Am Coll Cardiol. 21 (3): 655–61. doi: 10.1016/0735-1097(93)90098-L . PMID   8436747.
  51. ↑ Adigun AQ, Ajayi AA (2001). "The effects of enalapril-digoxin-diuretic combination therapy on nutritional and anthropometric indices in chronic congestive heart failure: preliminary findings in cardiac cachexia". European Journal of Heart Failure. 3 (3): 359–63. doi: 10.1016/S1388-9842(00)00146-X . PMID   11378008. S2CID   31118266.
  52. ↑ Anker SD, Ponikowski P, Varney S, Chua TP, Clark AL, Webb-Peploe KM, et al. (1997). "Wasting as independent risk factor for mortality in chronic heart failure". The Lancet. 349 (9058): 1050–3. doi:10.1016/S0140-6736(96)07015-8. PMID   9107242. S2CID   27285694.
  53. ↑ von Haehling S, Morley JE, Anker SD (December 2010). "An overview of sarcopenia: facts and numbers on prevalence and clinical impact". J Cachexia Sarcopenia Muscle. 1 (2): 129–133. doi:10.1007/s13539-010-0014-2. PMC   3060646 . PMID   21475695.
  54. ↑ "Angiotensin-Converting Enzyme (ACE) Inhibitors". Cleveland Clinic. Retrieved 2022-11-05.
  55. ↑ "Lisinopril". go.drugbank.com. Retrieved 2022-11-05.
  56. 1 2 3 4 Shibata S, Fujita T (2018). "Renin Angiotensin Aldosterone System Blockers". Hypertension: A Companion to Braunwald's Heart Disease. Elsevier. pp. 230–241. doi:10.1016/b978-0-323-42973-3.00024-x. ISBN   978-0-323-42973-3. ACE inhibitors are classified according to the chemical structure of the site of binding (sulfhydryl, phosphinyl, carboxyl) to the active center of ACE.
  57. ↑ Kumar R, Chaudhary K, Sharma M, Nagpal G, Chauhan JS, Singh S, et al. (2015). "AHTPDB: a comprehensive platform for analysis and presentation of antihypertensive peptides". Nucleic Acids Res. 43 (Database issue): D956–62. doi:10.1093/nar/gku1141. PMC   4383949 . PMID   25392419.
  58. ↑ "US4013791A - Peptides having an antihypertensive effect". Google Patents. 1975-12-03. Retrieved 2020-03-21.
  59. ↑ FitzGerald RJ, Murray BA, Walsh DJ (2004). "Hypotensive peptides from milk proteins". The Journal of Nutrition. 134 (4): 980S–8S. doi: 10.1093/jn/134.4.980S . PMID   15051858.
  60. ↑ Aihara K, Kajimoto O, Hirata H, Takahashi R, Nakamura Y (2005). "Effect of powdered fermented milk with Lactobacillus helveticus on subjects with high-normal blood pressure or mild hypertension". Journal of the American College of Nutrition. 24 (4): 257–65. doi:10.1080/07315724.2005.10719473. PMID   16093403. S2CID   18513821.
  61. 1 2 Boelsma E, Kloek J (2009). "Lactotripeptides and antihypertensive effects: a critical review". The British Journal of Nutrition. 101 (6): 776–86. doi: 10.1017/S0007114508137722 . PMID   19061526.
  62. ↑ Minervini F, Algaron F, Rizzello CG, Fox PF, Monnet V (2003). "Angiotensin I-Converting-Enzyme-Inhibitory and Antibacterial Peptides from Lactobacillus helveticus PR4 Proteinase-Hydrolyzed Caseins of Milk from Six Species". Applied and Environmental Microbiology. 69 (9): 5297–5305. Bibcode:2003ApEnM..69.5297M. doi:10.1128/AEM.69.9.5297-5305.2003. PMC   194939 . PMID   12957917.
  63. ↑ "Debate: Do ACE Inhibitors Have Unique Properties, Beyond Their Antihypertensive Effect?"
  64. ↑ The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators (October 1993). "Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure". Lancet. 342 (8875): 821–8. doi:10.1016/0140-6736(93)92693-N. PMID   8104270. S2CID   5770772.
  65. ↑ van Vark LC, Bertrand M, Akkerhuis KM, Brugts JJ, Fox K, Mourad JJ, et al. (2012). "Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin–angiotensin–aldosterone system inhibitors involving 158,998 patients". Eur Heart J. 33 (16): 2088–97. doi:10.1093/eurheartj/ehs075. PMC   3418510 . PMID   22511654.
  66. ↑ What are the dose comparisons of all ACE inhibitors used in hypertension? Archived 2015-04-02 at the Wayback Machine TripAnswers, Trip, May 25, 2007. Accessed 2009-11-21
  67. ↑ Common Medication Conversions (Equivalents): Ace Inhibitors Archived 2015-03-17 at the Wayback Machine . GlobalRPh.com. Accessed 2009-11-22.
  68. ↑ Treating High Blood Pressure and Heart Disease: the ACE Inhibitors. Consumer Reports Health Best Buy Drugs. June 2009.
  69. ↑ Dimopoulos NA, Salukhe TV, Coats AJ, Mayet J, Piepoli M, Francis DP (2004). "Meta-analyses of mortality and morbidity effects of an angiotensin receptor blocker in patients with chronic heart failure already receiving an ACE inhibitor (alone or with a beta-blocker)". Int J Cardiol. 93 (2): 105–111. doi:10.1016/j.ijcard.2003.10.001. PMID   14975535.
  70. 1 2 Luno J, Praga M, de Vinuesa SG (2005). "The reno-protective effect of the dual blockade of the renin angiotensin system (RAS)". Current Pharmaceutical Design. 11 (10): 1291–300. doi:10.2174/1381612053507413. PMID   15853685.
  71. ↑ van de Wal RM, van Veldhuisen DJ, van Gilst WH, Voors AA (2005). "Addition of an angiotensin receptor blocker to full-dose ACE-inhibition: controversial or common sense?". European Heart Journal . 26 (22): 2361–7. doi: 10.1093/eurheartj/ehi454 . PMID   16105846.
  72. ↑ ONTARGET Investigators, Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, et al. (10 April 2008). "Telmisartan, ramipril, or both in patients at high risk for vascular events" (PDF). The New England Journal of Medicine. 358 (15): 1547–59. doi:10.1056/NEJMoa0801317. hdl: 2437/81925 . PMID   18378520. Archived (PDF) from the original on 2022-10-09.
  73. ↑ Finnegan PM, Gleason BL (2003). "Combination ACE inhibitors and angiotensin II receptor blockers for hypertension". Annals of Pharmacotherapy. 37 (6): 886–9. doi:10.1345/aph.1C393. PMID   12773079. S2CID   25509704.
  74. ↑ Shelley Wood (11 April 2014). "EMA: Don't Combine ARBs, ACE Inhibitors, and Direct Renin Inhibitors". www.medscape.com.
  75. ↑ Krum H, Carson P, Farsang C, Maggioni AP, Glazer RD, Aknay N, et al. (2004). "Effect of valsartan added to background ACE inhibitor therapy in patients with heart failure: results from Val-HeFT". European Journal of Heart Failure. 6 (7): 937–45. doi: 10.1016/j.ejheart.2004.09.005 . PMID   15556056. S2CID   40739892.
  76. ↑ Solomon SD, Skali H, Anavekar NS, Bourgoun M, Barvik S, Ghali JK, et al. (2005). "Changes in Ventricular Size and Function in Patients Treated with Valsartan, Captopril, or Both After Myocardial Infarction". Circulation. 111 (25): 3411–3419. doi: 10.1161/CIRCULATIONAHA.104.508093 . PMID   15967846.
  77. ↑ Yang Y, Ohta K, Shimizu M, Nakai A, Kasahara Y, Yachie A, et al. (Jul 2005). "Treatment with low-dose angiotensin-converting enzyme inhibitor (ACEI) plus angiotensin II receptor blocker (ARB) in pediatric patients with IgA nephropathy". Clinical Nephrology. 64 (1): 35–40. doi:10.5414/CNP64035. PMID   16047643.
  78. ↑ Bernstein KE, Ong FS, Blackwell WL, Shah KH, Giani JF, Gonzalez-Villalobos RA, et al. (January 2013). "A Modern Understanding of the Traditional and Nontraditional Biological Functions of Angiotensin-Converting Enzyme". Pharmacological Reviews. 65 (1): 1–46. doi:10.1124/pr.112.006809. ISSN   0031-6997. PMC   3565918 . PMID   23257181.
  79. ↑ Myat A, Gershlick AH, Gershlick T (2012). "17. Systemic arterial hypertension". Landmark Papers in Cardiovascular Medicine. Oxford: Oxford University Press. pp. 2286–287. ISBN   978-0-19-959476-4. LCCN   2012940771.
  80. ↑ Ferreira SH (February 1965). "A bradykinin-potentiating factor (bpf) present in the venom of bothrops jararaca". Br J Pharmacol Chemother. 24 (1): 163–9. doi:10.1111/j.1476-5381.1965.tb02091.x. PMC   1704050 . PMID   14302350.
  81. ↑ Ng KK, Vane JR (1967). "Conversion of Angiotensin I to Angiotensin II". Nature. 216 (5117): 762–6. Bibcode:1967Natur.216..762N. doi:10.1038/216762a0. PMID   4294626. S2CID   4289093.
  82. ↑ Ng KK, Vane JR (1968). "Fate of Angiotensin I in the Circulation". Nature. 218 (5137): 144–50. Bibcode:1968Natur.218..144N. doi:10.1038/218144a0. PMID   4296306. S2CID   4174541.
  83. ↑ Ng KK, Vane JR (1970). "Some Properties of Angiotensin Converting Enzyme in the Lung in vivo". Nature. 225 (5238): 1142–4. Bibcode:1970Natur.225.1142N. doi:10.1038/2251142b0. PMID   4313869. S2CID   4200012.
  84. ↑ Cushman DW, Ondetti MA (1991). "History of the design of captopril and related inhibitors of angiotensin converting enzyme". Hypertension. 17 (4): 589–592. doi: 10.1161/01.HYP.17.4.589 . PMID   2013486. S2CID   30766421.
  85. ↑ "Drugs@FDA: FDA-Approved Drugs". www.accessdata.fda.gov. Retrieved 2023-09-29.
  86. ↑ "Drugs@FDA: FDA-Approved Drugs". www.accessdata.fda.gov. Retrieved 2023-09-29.
  87. ↑ Bicket DP (2002-08-01). "Using ACE Inhibitors Appropriately". American Family Physician. 66 (3): 461–469. PMID   12182524.
  88. ↑ Hata Y, Yamamoto M, Ohni M, Nakajima K, Nakamura Y, Takano T (1996). "A placebo-controlled study of the effect of sour milk on blood pressure in hypertensive subjects". The American Journal of Clinical Nutrition. 64 (5): 767–71. doi: 10.1093/ajcn/64.5.767 . PMID   8901799.
  89. ↑ Nakamura Y, Yamamoto N, Sakai K, Takano T (1995). "Antihypertensive effect of sour milk and peptides isolated from it that are inhibitors to angiotensin I-converting enzyme". Journal of Dairy Science . 78 (6): 1253–7. doi: 10.3168/jds.S0022-0302(95)76745-5 . PMID   7673515.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.