[Resistance to ACE inhibitors. Myth or reality?]

Area of Science:

• Cardiology
• Pharmacology
• Biochemistry

Context:

• Angiotensin Converting Enzyme (ACE) inhibitors are crucial in managing hypertension and cardiovascular diseases.
• These drugs offer cardio and vascular protection by addressing hypertension, left ventricular hypertrophy, endothelial dysfunction, and more.
• A significant question remains regarding potential resistance to ACE inhibitors, with concerns about ongoing left ventricular remodelling and smooth muscle proliferation despite treatment.

Purpose:

• To investigate the phenomenon of potential resistance to Angiotensin Converting Enzyme (ACE) inhibitors.
• To explore alternative pathways for angiotensin II synthesis beyond the action of ACE.
• To determine if left ventricular remodelling and arterial smooth muscle proliferation persist with standard ACE inhibitor therapy.

Summary:

• Angiotensin II synthesis involves factors beyond ACE, including angiotensin I quality and enzymes like chymase.
• Secondary increases in angiotensin II during ACE inhibitor therapy might indicate incomplete renin-angiotensin system blockade or alternative synthesis routes.
• In vivo studies suggest that the renin-angiotensin system's blockade is tightly regulated, potentially limiting the efficacy of ACE inhibitors.

Impact:

• Highlights the complexity of the renin-angiotensin system and its regulation.
• Suggests a need for further research into alternative therapeutic strategies for cardiovascular conditions.
• Informs clinical practice regarding the potential limitations of ACE inhibitors and the need for monitoring treatment effectiveness.