Angiotensin converting enzyme inhibition and vascular hypertrophy in hypertension

The pathogenesis of hypertension is associated with a remodeling of vascular structure. Follow has postulated that the decreased luminal area and thickened medial layer in hypertensive vessels enhances the vasoconstrictive response to vasoactive agents. It is hypothesized that this increase in vascular reactivity may serve to perpetuate hypertension. A growing body of evidence suggests that autocrine-paracrine vasoactive substances and growth factors modulate vascular structure in hypertension. We speculate that therapeutic interventions that normalize blood pressure as well as reverse the vascular remodeling process may have special clinical value. The role of the paracrine renin-angiotensin system and angiotensin converting enzyme inhibitors in hypertension is discussed in this context.