Angiotensin-converting enzyme inhibitor therapy after heart transplant: From molecular basis to clinical effects

Area of Science:

• Cardiovascular Medicine
• Transplantation Immunology
• Pharmacology

Background:

• Angiotensin-converting enzyme inhibitors (ACEi) are established therapies for cardiovascular diseases like hypertension, ischemic heart disease, and heart failure (HF).
• In heart transplant recipients (HTRs), ACEi are crucial for hypertension management, offering pleiotropic effects on vascular function and fluid balance.

Purpose of the Study:

• To review the role and potential benefits of ACE inhibitors in heart transplant recipients.
• To highlight the pleiotropic effects of ACEi in HTRs, including prevention of graft failure, cardiac allograft vasculopathy (CAV), and chronic kidney disease (CKD).

Main Methods:

• Literature review of studies on ACE inhibitor use in cardiovascular diseases and heart transplant recipients.
• Analysis of the molecular and clinical effects of ACEi in the context of HTRs.

Main Results:

• ACEi demonstrate significant benefits in HTRs, including effective hypertension control and potential prevention of CAV and CKD progression.
• ACEi exhibit pleiotropic effects, improving peripheral vascular function and regulating fluid and sodium balance.

Conclusions:

• ACE inhibitors are a cornerstone therapy for HTRs, offering multifaceted benefits beyond blood pressure control.
• Further multicenter, randomized studies are essential to validate the clinical efficacy of ACEi in HTRs and support wider adoption.
• Investigating novel renin-angiotensin-aldosterone system inhibitors, like sacubitril, in HTRs is a promising future direction.