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Related Concept Videos

Antihypertensive Drugs: Direct Renin Inhibitors01:25

Antihypertensive Drugs: Direct Renin Inhibitors

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The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
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Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors01:30

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Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
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Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Antihypertensive Drugs: Angiotensin II Receptor Blockers01:30

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In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
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Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
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Myocarditis III: Medical Management01:14

Myocarditis III: Medical Management

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Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
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Angiotensin-Converting Enzyme (ACE) Inhibitors May Moderate COVID-19 Hyperinflammatory Response: An Observational

Venkata R Duvvuri1, Andrew Baumgartner1, Sevda Molani1

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Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-II receptor blockers (ARB) use did not increase COVID-19 risks. ACEi use was linked to decreased mortality and may moderate hyperinflammation, supporting continued treatment.

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Area of Science:

  • Cardiovascular Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-II receptor blockers (ARB) are common antihypertensives that affect the renin-angiotensin-aldosterone system (RAAS).
  • ACE2, upregulated by ACEi/ARB, is the SARS-CoV-2 entry receptor, raising concerns about their impact on COVID-19 outcomes.

Purpose of the Study:

  • To evaluate the association between RAAS inhibitors and COVID-19 outcomes, including mechanical ventilation and mortality.
  • To investigate the effect of ACEi on immune cell gene expression in COVID-19 patients.

Main Methods:

  • Retrospective analysis of electronic health records (EHRs) using unmatched and propensity score (PS)-matched cohorts.
  • Assessment of invasive mechanical ventilation (IMV) risk and 30-day mortality.
  • Analysis of immune cell gene expression profiles in a prospective cohort.

Main Results:

  • No increased risk of adverse COVID-19 outcomes (IMV, mortality) was found with ACEi or ARB use.
  • ACEi use was associated with a decreased risk of mortality.
  • ACEi users showed upregulated expression of anti-inflammatory (IL1RL2) and immunosuppressive (RETN) genes in monocytes.

Conclusions:

  • Findings do not support discontinuing ACEi or ARB for COVID-19 patients.
  • ACEi may mitigate the hyperinflammatory response in COVID-19, suggesting a potential protective role.