ACE inhibitor

A class of drugs (angiotensin-converting enzyme inhibitors) that block the conversion of angiotensin I to angiotensin II, used in the treatment of hypertension and congestive heart failure and in the prevention of microvascular complications of diabetes mellitus (DM).

The renin-angiotensin system is involved in the regulation of blood pressure and electrolyte balance. Angiotensinogen, a globulin formed in the liver, is converted to angiotensin I by renin, an enzyme produced by the juxtaglomerular cells of renal afferent arterioles. Renin release can be triggered by a drop in systemic blood pressure (either directly through baroreceptors or indirectly through reduction in renal tubular fluid, as in hypotension or dehydration) or in serum sodium chloride concentration. Angiotensin I is converted by the ACE, a glycoprotein produced chiefly in the lung, to angiotensin II. (ACE also degrades bradykinin, a vasodilator.) Angiotensin II is a potent vasoconstrictor and neurotransmitter, which raises peripheral vascular resistance and induces sodium retention by stimulating the adrenal cortex to secrete aldosterone. In addition, angiotensin II stimulates cell migration and the growth and proliferation of vascular smooth muscle. Because it plays a pivotal role in the pathogenesis of essential hypertension, congestive heart failure, and diabetic nephropathy, drugs that block production of angiotensin II are useful in those disorders. ACE inhibitors have an established place in the treatment of essential hypertension, congestive heart failure, and left ventricular dysfunction after myocardial infarction. Their effectiveness in hypertension is less marked in black patients than in nonblacks. ACE inhibitors may lessen cardiovascular risk by improving endothelial dysfunction, reducing inflammation, and promoting fibrinolysis by inhibiting plasminogen activator inhibitor-1. The protection afforded by these agents against vascular complications of DM is independent of their effect on blood pressure. They can slow the progression of diabetic nephropathy in patients with Type 1 DM, and of microalbuminuria in those with Type 2 DM, even in the absence of hypertension. Studies have shown a 50% reduction in the risk of the combined end-points of death, dialysis, and renal transplantation in patients with Type 1 DM who were treated with the ACE inhibitor captopril. In addition, ACE inhibitors may prevent development of DM in nondiabetic hypertensive patients. Their potentiation of the effects of bradykinin may account for their ability to enhance insulin sensitivity and may explain their apparent benefit in preventing new-onset Type 2 DM. The usefulness of these agents is limited by their tendency to elevate levels of blood urea nitrogen and creatinine, particularly in conjunction with diuretic therapy and in patients with renal disease or congestive heart failure, and to cause nonproductive cough.

ACE inhibitor

(ās)n. Any of a class of drugs that cause vasodilation and are used to treat hypertension and heart failure.

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).

ACE inhibitor

Angiotensin-converting enzyme inhibitor Pharmacology Any of a family of drugs that are used to manage essential HTN, ↓ CHF-related M&M Pros ACEIs are cardioprotective and vasculoprotective; cardioprotective effects include improved hemodynamics and electric stability, ↓ SNS activity and ↓ left ventricular mass; vasculoprotective benefits include improved endothelial function, vascular compliance and tone, and direct antiproliferative and antiplatelet effects; ACEIs also stimulate PG synthesis, ↓ the size of MIs, ↓ reperfusion injury and complex ventricular arrhythmias; ACEIs are the treatment of choice in CHF with systolic dysfunction; they are vasodilators which ↓ preload and afterload; ACEI-induced ↓ in angiotensin II inhibits the release of aldosterone, which in turn ↓ sodium and water retention which, by extension, ↓ preload; ACEIs improve hemodynamics of CHF by ↓ right atrial pressure, pulmonary capillary wedge pressure, arterial BP, as well as pulmonary and systemic vascular resistances; ACEIs ↑ cardiac and stroke indices by the left ventricle and ↓ the right ventricular end-diastolic volumes, thereby resulting in ↑ cardiac output, while simultaneously ↓ cardiac load and myocardial O₂ consumption; ACEIs also downregulate the SNS, which is linked to the pathogenesis of CHF Adverse effects Idiopathic–eg, rashes, dysgeusia, BM suppression; class-specific–eg, hypotension, renal impairment, hyperkalemia, cough, angioneurotic edema, the latter 2 of which are mediated by small vasoactive substances, eg, bradykinin, substance P, and PG-related factors

ACE inhibitor Effects in Heart Disease

Cardioprotective effects

Restores balance between myocardial O₂ supply & demand
Reduces left ventricular preload and afterload
Reduces left ventricular mass
Reduces sympathetic stimulation

Vasculoprotective effects

Antiproliferative & antimigratory effects on smooth muscle & inflammatory cells
Antiplatelet effects
Improved arterial compliance and tone
Improved and or restored endothelial function
Antihypertensive
Possibly, antiatherosclerotic effect

After Lonn et al, 1994

Angiotensin-converting enzyme (ACE) inhibitor

A drug that relaxes blood vessel walls and lowers blood pressure.Mentioned in: Congestive Cardiomyopathy, Heart Failure

ACE in·hi·bi·tor

(ās in-hibi-tŏr) Class of drugs (angiotensin-converting enzyme inhibitors) that blocks conversion of angiotensin I to angiotensin II; used to treat hypertension and other disorders.

单词	ace inhibitor
释义	ACE inhibitor ACE inhibitor (ā'sē'ē`, ās) or angiotensin-converting enzyme inhibitor (ăn'jēōtĕn`sĭn), drug used to reduce elevated blood pressure (see hypertensionhypertension or high blood pressure, elevated blood pressure resulting from an increase in the amount of blood pumped by the heart or from increased resistance to the flow of blood through the small arterial blood vessels (arterioles). ..... Click the link for more information. ), to treat congestive heart failurecongestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. ..... Click the link for more information. , and to alleviate strain on hearts damaged as a result of a heart attack (see infarctioninfarction, blockage of blood circulation to a localized area or organ of the body resulting in tissue death. Infarctions commonly occur in the spleen, kidney, lungs, brain, and heart. ..... Click the link for more information. ). ACE inhibitors block production of an enzyme that helps convert the protein angiotensin 1 into angiotensin 2, a protein that makes blood vessels constrict and promotes retention of fluid, raising blood pressure. Thus ACE inhibitors act to widen the blood vessels and make it easier for the heart to pump blood through the body. captopril (Capoten), ramipril (Altace), and enalapril (Vasotec) are commonly used ACE inhibitors. Angiotensin-receptor blockers (ARBs), such as losartan (Cozaar) and valsartan (Diovan), reduce hypertension by displacing angiotensin 2 from receptors on the surface of cells. ARBs are used as alternatives to the less expensive ACE inhibitors because they have fewer side effects. ACE inhibitor ACE inhibitor A class of drugs (angiotensin-converting enzyme inhibitors) that block the conversion of angiotensin I to angiotensin II, used in the treatment of hypertension and congestive heart failure and in the prevention of microvascular complications of diabetes mellitus (DM). The renin-angiotensin system is involved in the regulation of blood pressure and electrolyte balance. Angiotensinogen, a globulin formed in the liver, is converted to angiotensin I by renin, an enzyme produced by the juxtaglomerular cells of renal afferent arterioles. Renin release can be triggered by a drop in systemic blood pressure (either directly through baroreceptors or indirectly through reduction in renal tubular fluid, as in hypotension or dehydration) or in serum sodium chloride concentration. Angiotensin I is converted by the ACE, a glycoprotein produced chiefly in the lung, to angiotensin II. (ACE also degrades bradykinin, a vasodilator.) Angiotensin II is a potent vasoconstrictor and neurotransmitter, which raises peripheral vascular resistance and induces sodium retention by stimulating the adrenal cortex to secrete aldosterone. In addition, angiotensin II stimulates cell migration and the growth and proliferation of vascular smooth muscle. Because it plays a pivotal role in the pathogenesis of essential hypertension, congestive heart failure, and diabetic nephropathy, drugs that block production of angiotensin II are useful in those disorders. ACE inhibitors have an established place in the treatment of essential hypertension, congestive heart failure, and left ventricular dysfunction after myocardial infarction. Their effectiveness in hypertension is less marked in black patients than in nonblacks. ACE inhibitors may lessen cardiovascular risk by improving endothelial dysfunction, reducing inflammation, and promoting fibrinolysis by inhibiting plasminogen activator inhibitor-1. The protection afforded by these agents against vascular complications of DM is independent of their effect on blood pressure. They can slow the progression of diabetic nephropathy in patients with Type 1 DM, and of microalbuminuria in those with Type 2 DM, even in the absence of hypertension. Studies have shown a 50% reduction in the risk of the combined end-points of death, dialysis, and renal transplantation in patients with Type 1 DM who were treated with the ACE inhibitor captopril. In addition, ACE inhibitors may prevent development of DM in nondiabetic hypertensive patients. Their potentiation of the effects of bradykinin may account for their ability to enhance insulin sensitivity and may explain their apparent benefit in preventing new-onset Type 2 DM. The usefulness of these agents is limited by their tendency to elevate levels of blood urea nitrogen and creatinine, particularly in conjunction with diuretic therapy and in patients with renal disease or congestive heart failure, and to cause nonproductive cough. ACE inhibitor (ās)n. Any of a class of drugs that cause vasodilation and are used to treat hypertension and heart failure. 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). ACE inhibitor Angiotensin-converting enzyme inhibitor Pharmacology Any of a family of drugs that are used to manage essential HTN, ↓ CHF-related M&M Pros ACEIs are cardioprotective and vasculoprotective; cardioprotective effects include improved hemodynamics and electric stability, ↓ SNS activity and ↓ left ventricular mass; vasculoprotective benefits include improved endothelial function, vascular compliance and tone, and direct antiproliferative and antiplatelet effects; ACEIs also stimulate PG synthesis, ↓ the size of MIs, ↓ reperfusion injury and complex ventricular arrhythmias; ACEIs are the treatment of choice in CHF with systolic dysfunction; they are vasodilators which ↓ preload and afterload; ACEI-induced ↓ in angiotensin II inhibits the release of aldosterone, which in turn ↓ sodium and water retention which, by extension, ↓ preload; ACEIs improve hemodynamics of CHF by ↓ right atrial pressure, pulmonary capillary wedge pressure, arterial BP, as well as pulmonary and systemic vascular resistances; ACEIs ↑ cardiac and stroke indices by the left ventricle and ↓ the right ventricular end-diastolic volumes, thereby resulting in ↑ cardiac output, while simultaneously ↓ cardiac load and myocardial O₂ consumption; ACEIs also downregulate the SNS, which is linked to the pathogenesis of CHF Adverse effects Idiopathic–eg, rashes, dysgeusia, BM suppression; class-specific–eg, hypotension, renal impairment, hyperkalemia, cough, angioneurotic edema, the latter 2 of which are mediated by small vasoactive substances, eg, bradykinin, substance P, and PG-related factors ACE inhibitor Effects in Heart Disease Cardioprotective effects Restores balance between myocardial O₂ supply & demand Reduces left ventricular preload and afterload Reduces left ventricular mass Reduces sympathetic stimulation Vasculoprotective effects Antiproliferative & antimigratory effects on smooth muscle & inflammatory cells Antiplatelet effects Improved arterial compliance and tone Improved and or restored endothelial function Antihypertensive Possibly, antiatherosclerotic effect After Lonn et al, 1994 Angiotensin-converting enzyme (ACE) inhibitor A drug that relaxes blood vessel walls and lowers blood pressure.Mentioned in: Congestive Cardiomyopathy, Heart Failure ACE in·hi·bi·tor (ās in-hibi-tŏr) Class of drugs (angiotensin-converting enzyme inhibitors) that blocks conversion of angiotensin I to angiotensin II; used to treat hypertension and other disorders. ACE inhibitor Related to ACE inhibitor: Angiotensin receptor blocker, Beta blockers noun Synonyms for ACE inhibitor noun an antihypertensive drug that blocks the formation of angiotensin II in the kidney, leading to relaxation of the arteries Synonyms angiotensin-converting enzyme inhibitor Related Words antihypertensive antihypertensive drug Capoten captopril enalapril Vasotec lisinopril Prinival Zestril Altace ramipril Mavik trandolapril
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ACE inhibitor

ACE inhibitor

angiotensin-converting enzyme inhibitor

ACE inhibitor

ACE inhibitor

ACE inhibitor

ACE inhibitor

ACE inhibitor

ACE inhibitor Effects in Heart Disease

Cardioprotective effects

Vasculoprotective effects

After Lonn et al, 1994

Angiotensin-converting enzyme (ACE) inhibitor

ACE in·hi·bi·tor

ACE inhibitor

Synonyms for ACE inhibitor

noun an antihypertensive drug that blocks the formation of angiotensin II in the kidney, leading to relaxation of the arteries

Synonyms

Related Words