List of ace inhibitors

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Comprehensive List of ACE Inhibitors

Introduction to ACE Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are a class of medications widely used to treat hypertension and various cardiovascular and renal diseases. They work by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby reducing blood pressure and promoting vasodilation and natriuresis . This article provides a detailed list of both synthetic and natural ACE inhibitors, highlighting their pharmacokinetic properties, therapeutic uses, and potential side effects.

Synthetic ACE Inhibitors

Commonly Used Synthetic ACE Inhibitors

Several synthetic ACE inhibitors are frequently prescribed for managing hypertension and related conditions. These include:

Captopril: The first orally active ACE inhibitor, known for its rapid onset and short duration of action .
Enalapril: A prodrug converted to enalaprilat, which has a longer duration of action compared to captopril .
Lisinopril: Not a prodrug, with almost solely renal elimination, making it suitable for patients with liver dysfunction.
Ramipril: Known for its long half-life and high trough-to-peak ratio, making it effective for once-daily dosing.
Fosinopril: Unique for its dual route of elimination (renal and hepatic), reducing the need for dosage adjustment in patients with renal impairment.

Newer ACE Inhibitors

Recent developments have introduced newer ACE inhibitors with improved pharmacokinetic profiles:

Zofenopril: A prodrug with greater potency and longer duration of action than captopril, partially eliminated through the liver.
Benazepril, Cilazapril, and Quinapril: Carboxyl-containing prodrugs with varying peak times and half-lives, offering flexibility in clinical use.
Fosinopril: A phosphoryl-containing ACE inhibitor with a long half-life and partial hepatic elimination.

Natural ACE Inhibitors

Plant-Based ACE Inhibitors

The search for natural ACE inhibitors has identified numerous plant species with significant ACE-inhibitory activity. Some of the most potent include:

Angelica keiskei
Momordica charantia
Muntingia calabura
Prunus domestica
Peperomia pellucida

Bioactive Metabolites

Several bioactive compounds isolated from plants and fungi have shown promising ACE-inhibitory activity:

Peptides: Tyr-Glu-Pro, Met-Arg-Trp, and Gln-Phe-Tyr-Ala-Val
Phenolics: Cyanidin-3-O-sambubioside and delphinidin-3-O-sambubioside
Flavonoids: [-]-Epicatechin, astilbin, and eupatorin
Terpenoids: Ursolic acid and oleanolic acid
Alkaloids: Berberine and harmaline

Soybean-Derived Peptides

Soybean protein isolate hydrolysate (SPIH) has been identified as a source of potent ACE-inhibitory peptides, such as IY, YVVF, LVF, WMY, LVLL, and FF, which exhibit significant ACE inhibition and potential therapeutic benefits.

Therapeutic Implications and Safety

Clinical Efficacy

ACE inhibitors are effective in reducing blood pressure, decreasing mortality in congestive heart failure, and delaying the progression of diabetic nephropathy . They also exhibit antioxidant properties, which may provide additional cardiovascular benefits.

Side Effects and Safety Concerns

While synthetic ACE inhibitors are effective, they can cause side effects such as hypotension, renal insufficiency, and hyperkalemia. Natural ACE inhibitors from plants may offer a safer alternative with minimal side effects and lower toxicity.

Conclusion

ACE inhibitors, both synthetic and natural, play a crucial role in managing hypertension and related cardiovascular and renal diseases. The development of newer synthetic ACE inhibitors and the discovery of potent natural inhibitors from plants and soybeans offer promising avenues for safer and more effective treatments. Understanding the pharmacokinetic and therapeutic differences among these inhibitors can help optimize clinical outcomes and minimize adverse effects.