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[Arterial hypertension, renal function and angiotensin-converting enzyme inhibition]
J Ribstein1, G Mourad, A Mimran
1Service de Médecine interne et Néphrologie, Hôpital Lapeyronie, Montpellier.
Insights
Angiotensin converting-enzyme inhibitors (ACEI) impact kidney function, influencing blood pressure regulation and sodium balance. ACEI may offer renal protection, particularly in conditions like diabetes mellitus.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Pharmacology
Context:
- Antihypertensive treatments, specifically ACE inhibitors, exert effects best understood at the renal level.
- Renal artery stenosis activates the intrarenal renin-angiotensin system to maintain glomerular filtration.
- Long-term hypertension may alter the intrarenal renin-angiotensin system and renal function curves.
Purpose:
- To explore the renal effects of angiotensin converting-enzyme inhibitors (ACEI) in hypertension.
- To investigate how ACEI influence sodium conservation and renal responses to angiotensin.
- To examine the potential for ACEI in renal protection, including in diabetic patients.
Summary:
- ACEI influence renal hemodynamics and sodium handling, particularly in conditions like renal artery stenosis.
- In essential hypertension, ACEI may correct sodium-related abnormalities in the renin-angiotensin system.
- Renal-level effects of ACEI are crucial for understanding their therapeutic benefits and potential for renal protection.
Impact:
- Understanding the renal mechanisms of ACEI is vital for optimizing antihypertensive therapy.
- ACEI may offer significant renal protection in specific patient populations, such as those with diabetes.
- Further research into ACEI's renal effects could lead to novel therapeutic strategies for kidney disease and hypertension.
Abstract:
Several effects of the antihypertensive treatment with angiotensin converting-enzyme inhibitors (ACEI)--whether beneficial or detrimental--are best explained at the renal level. In the presence of a renal artery stenosis, the activation of the intrarenal renin-angiotensin system is first directed at maintaining glomerular filtration and intracapillary hydrostatic pressure through post-glomerular vasoconstriction. Long-term elevation of blood pressure is associated with a shift of the renal function curve, possibly linked with an alteration of the intrarenal renin-angiotensin system. Inhibition of the converting enzyme does affect the mechanisms of sodium conservation. In a subset of essential hypertensive subjects, ACEI may correct a subtle primary abnormality in modulation by sodium of renal (and adrenal) response(s) to angiotensin. Finally, the possibility of renal protection in circumstances such as diabetes mellitus, provides an exciting area of investigations for antihypertensive treatment with ACEI.