What is an ace inhibitor used for
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Uses of ACE Inhibitors: A Comprehensive Overview
Introduction to ACE Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors are a class of medications primarily used to manage cardiovascular and renal diseases. These drugs work by inhibiting the enzyme responsible for converting angiotensin I to angiotensin II, a potent vasoconstrictor, thereby promoting vasodilation and reducing blood pressure1 2 3.
Treatment of Hypertension
Mechanism and Efficacy
ACE inhibitors are widely recognized for their efficacy in treating hypertension. By decreasing the formation of angiotensin II and increasing bradykinin levels, they help relax blood vessels, reduce blood volume, and lower blood pressure1 2 3. This makes them a cornerstone in the management of high blood pressure10.
Benefits and Side Effects
While effective, ACE inhibitors can have side effects such as renal insufficiency and hyperkalemia, particularly when combined with other medications like potassium-sparing diuretics6. Efforts are ongoing to develop more selective ACE inhibitors to minimize these adverse effects5.
Management of Heart Failure
Reducing Mortality and Symptoms
ACE inhibitors have been shown to reduce mortality and alleviate symptoms in patients with congestive heart failure. They achieve this by decreasing systemic vascular resistance without increasing heart rate, promoting natriuresis, and stabilizing plaques1 2 7. These benefits extend to patients with both ischemic and non-ischemic causes of left ventricular dysfunction8.
Impact on Left Ventricular Dysfunction
Clinical trials have demonstrated that ACE inhibitors can prevent the progression of left ventricular dysfunction and reduce hospitalizations for heart failure. This is partly due to their beneficial effects on left ventricular remodeling and reduction of left ventricular enlargement8 9.
Post-Myocardial Infarction Therapy
Improving Survival Rates
ACE inhibitors are also used post-myocardial infarction to improve survival rates and reduce the risk of subsequent cardiovascular events. They help in managing left ventricular dysfunction and preventing further ischemic events1 2 8.
Controversies and Considerations
However, their use in normotensive patients with coronary artery disease (CAD) but without left ventricular dysfunction remains controversial. While they generally benefit hypertensive patients with CAD, a significant fraction of normotensive patients may not experience the same benefits and could even deteriorate9.
Diabetic Nephropathy and Neuropathy
Slowing Disease Progression
ACE inhibitors are effective in delaying the progression of diabetic nephropathy and neuropathy. They achieve this by reducing the harmful effects of angiotensin II on the kidneys and promoting better glucose control in insulin-resistant states1 2 4.
Enhancing Glucose Uptake
In insulin-resistant conditions, ACE inhibitors can enhance glucose uptake in skeletal muscle, thereby improving overall glucose disposal. This is facilitated through mechanisms involving bradykinin and nitric oxide production4.
Emerging Uses and Research
Memory-Related Disorders and Cancer
Recent studies suggest that ACE inhibitors may have protective roles in memory-related disorders and certain types of cancer. These potential new uses are being explored through ongoing research1.
Development of Next-Generation Inhibitors
The discovery that ACE consists of two distinct domains (N- and C-domains) has led to the development of domain-selective ACE inhibitors. These next-generation drugs aim to be safer and more effective by targeting specific functions of the enzyme5.
Conclusion
ACE inhibitors are versatile medications with a broad range of applications in treating cardiovascular and renal diseases. Their ability to manage hypertension, heart failure, post-myocardial infarction conditions, and diabetic complications makes them invaluable in modern medicine. Ongoing research continues to expand their potential uses and improve their safety profile, promising even greater benefits in the future.
Sources and full results
Most relevant research papers on this topic
Reinventing the ACE inhibitors: some old and new implications of ACE inhibition
ACE inhibitors have been effective in treating cardiovascular and renal diseases for over 30 years, and their use has expanded to include memory-related disorders and cancer.
Highly CitedAngiotensin-converting enzyme inhibitors.
ACE inhibitors effectively treat hypertension, decrease mortality in congestive heart failure, and delay diabetic nephropathy progression, with potential for future use in essential hypertension and other conditions.
Highly CitedSmall molecule angiotensin converting enzyme inhibitors: A medicinal chemistry perspective
Recent research advances in ACE inhibitors have reduced adverse effects and improved their use in treating cardiovascular and kidney diseases.
Modulation of metabolic control by angiotensin converting enzyme (ACE) inhibition
ACE inhibitors can improve glucose control in insulin-resistant states through increased nitric oxide production and/or antagonism of angiotensin II action on skeletal muscle.
Highly CitedAce revisited: A new target for structure-based drug design
The three-dimensional molecular structure of human testis ACE offers a unique opportunity for rational drug design, potentially leading to safer and more effective next-generation ACE inhibitors for cardiovascular diseases.
Highly CitedACE Inhibitors
ACE inhibitors may cause excessive blood pressure reduction, hypotension, and increased potassium levels when combined with other drugs, and may cause lithium toxicity and severe hypersensitivity reactions in certain patients.
Angiotensin-converting enzyme inhibitors from plants: A review of their diversity, modes of action, prospects, and concerns in the management of diabetes-centric complications.
Plant extracts, such as Angelica keiskei, Momordica charantia, Muntingia calabura, Prunus domestica, and Peperomia pellucida, show potential as natural ACE inhibitors for treating diabetes-related complications with minimal side effects and lower toxicity.
Systematic ReviewEmerging role of angiotensin-converting enzyme inhibitors in cardiac and vascular protection.
ACE inhibitors show potential in reducing heart failure and ischemic events, potentially playing a role in preventing coronary artery disease and improving heart health.
Highly CitedACE-inhibitors in coronary artery disease?
ACE-inhibitors are recommended for patients with coronary artery disease and left ventricular dysfunction, but their use in normotensive patients with angina pectoris without left ventricular dysfunction is currently unclear.
Converting-enzyme inhibitors in the treatment of hypertension.
ACE inhibitors effectively treat hypertension, with their antioxidant activity being crucial for effective combination therapy.
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