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Effect of the renin--angiotensin system on the vessel wall: using ACE inhibition to improve endothelial function
1Orange County Heart Institute, Orange, CA 92868, USA. jmneutel@aol.com
Insights
Plasma renin activity and cardiovascular disease (CVD) risk are linked in hypertension. Blocking the renin-angiotensin system, particularly with angiotensin-converting enzyme (ACE) inhibitors, improves arterial health and may prevent CVD.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Endothelial Biology
Background:
- Plasma renin activity correlates with cardiovascular disease (CVD) incidence in hypertensive individuals.
- Angiotensin II (Ang II) significantly impacts blood pressure (BP) and promotes atherosclerosis via cardiovascular growth effects.
- The renin-angiotensin-bradykinin system is a key factor influencing endothelial structure and function in hypertension.
Purpose of the Study:
- To investigate the role of Ang II in hypertension-related atherosclerosis.
- To evaluate the impact of renin-angiotensin system blockade on arterial structure and function.
- To assess the potential of ACE inhibitors in managing hypertension and preventing CVD.
Main Methods:
- Review of existing data on the renin-angiotensin system, Ang II effects, and atherosclerosis.
- Analysis of studies examining the effects of renin-angiotensin system blockade on arterial properties.
- Evaluation of clinical outcomes associated with ACE inhibitor use in hypertensive and at-risk patients.
Main Results:
- Ang II mediates critical vessel wall changes contributing to atherosclerotic disease, independent of other factors.
- Renin-angiotensin system blockade significantly alters arterial structure and function, beyond BP reduction.
- ACE inhibitors demonstrate improvements in arterial compliance, potentially reducing cardiovascular events.
Conclusions:
- Blockade of the neurohormonal system, including ACE inhibition, is a crucial strategy for managing hypertension and preventing endothelial dysfunction.
- ACE inhibition offers benefits beyond BP control, making it suitable for patients at risk of CVD, even without existing hypertension.
- Ideal antihypertensive agents should provide consistent 24-hour BP control to mitigate risks associated with BP variability and protect during high-risk early morning hours.
Abstract:
Plasma renin activity and cardiovascular disease (CVD) incidence correlate closely in people with hypertension. The effects of angiotensin II (Ang II) on blood pressure (BP) are important in hypertensive patients; accumulating data suggest that the growth effects of Ang II in the cardiovascular system play a critical role in the development of atherosclerosis. Atherosclerosis development in hypertensive patients requires fundamental changes in endothelial structure and function. Key among the factors that may affect the endothelium is the renin--angiotensin--bradykinin system. Ang II, independent of other environmental and neurohormonal factors, mediates the vessel wall changes critical for the development of atherosclerotic disease. A strong correlation appears to exist between Ang II and CVD. Blockade of the renin-angiotensin system has a major impact on arterial structure and function independent of BP. Certain angiotensin-converting enzyme (ACE) inhibitors produce significant improvements in arterial compliance, which may yield a reduction in cardiovascular events. Blockade of the neurohormonal system may be a critical first-line approach to management of hypertension in an effort to prevent or reverse endothelial dysfunction. Moreover, the effects of ACE inhibition, in addition to its effect on BP, suggest that this therapeutic approach may be appropriate for managing patients at risk of CVD who do not yet have hypertension. The ideal antihypertensive agent should yield smooth, consistent BP control over the entire 24-hour period, both to avoid BP variability that places patients at increased risk of cardiovascular events and to offer protection during the vulnerable early morning hours when patients are well known to be at high risk.
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