Other meanings of ACE inhibitor
Pharmacology
ACE inhibitors (angiotensin-converting enzyme inhibitors) are a class of medications primarily used to treat hypertension and heart failure. They work by inhibiting the angiotensin-converting enzyme, which reduces the production of angiotensin II, a potent vasoconstrictor, and decreases the breakdown of bradykinin, leading to vasodilation and reduced blood pressure. First introduced in the 1980s with captopril, ACE inhibitors have become a cornerstone in cardiovascular therapy, also used for diabetic nephropathy and post-myocardial infarction management.
ACE inhibitors block the conversion of angiotensin I to angiotensin II by inhibiting the angiotensin-converting enzyme, primarily in the lungs and kidneys. Angiotensin II is a potent vasoconstrictor and stimulates aldosterone release, leading to sodium and water retention. By reducing angiotensin II levels, ACE inhibitors cause vasodilation, decrease aldosterone secretion, and lower blood pressure. They also inhibit the degradation of bradykinin, a vasodilatory peptide, which contributes to their hypotensive effects but also to the common side effect of dry cough.
ACE inhibitors are first-line therapy for hypertension, heart failure with reduced ejection fraction, and post-myocardial infarction to prevent remodeling. They slow the progression of diabetic nephropathy and reduce proteinuria in chronic kidney disease. In heart failure, they improve symptoms and reduce mortality, as demonstrated in landmark trials like SOLVD and CONSENSUS.1 They are also used in scleroderma renal crisis and to prevent cardiovascular events in high-risk patients.
The most common adverse effect is a dry, persistent cough, occurring in 5–20% of patients, due to bradykinin accumulation. Angioedema, though rare, is a potentially life-threatening reaction, more common in African Americans. Hyperkalemia can occur, especially in patients with renal impairment or those taking potassium-sparing diuretics. ACE inhibitors are contraindicated in pregnancy due to fetal renal toxicity and are associated with acute kidney injury in bilateral renal artery stenosis.
The development of captopril was inspired by a peptide found in the venom of the Brazilian pit viper Bothrops jararaca, which inhibits ACE. This discovery led to the first orally active ACE inhibitor. ACE inhibitors also have anti-inflammatory and anti-fibrotic effects beyond blood pressure lowering. They are used in veterinary medicine for dogs with heart failure. Genetic polymorphisms in ACE, such as the insertion/deletion variant, influence individual responses and cough risk.
ACE inhibitors are a mainstay of cardiovascular pharmacotherapy, with a rich history from snake venom to life-saving drugs.
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