Tissue converting enzyme and cardiovascular actions of converting enzyme inhibitors

The discovery of tissue renin-angiotensin systems (RAS) in organs controlling the cardiovascular system has opened new perspectives for our understanding of the cardiovascular actions of converting enzyme (CE) inhibitors. Direct application of CE inhibitors to the brain and heart entails distinct cardiovascular effects. Systemic treatment with CE inhibitors leads not only to an inhibition of the plasma RAS, but it also inhibits tissue CE in various organs and reduces local angiotensin II concentrations. Evidence is presented that oral CE inhibitor treatment markedly influences organ function of the heart, brain, and vascular wall independently of the plasma RAS. These findings are compatible with the concept that tissue CE inhibition contributes to the beneficial actions of CE inhibitors in cardiovascular disease.