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Cardiac effects of ACE inhibition
1Medical Department, University of Bergen School of Medicine, Haukeland Hospital, Bergen, Norway.
Insights
Angiotensin-converting enzyme (ACE) inhibitors effectively reduce blood pressure in patients with hypertension by lowering peripheral resistance. These drugs show promise for cardioprotection by reversing cardiac structural and functional changes.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension is linked to cardiac changes like left ventricular hypertrophy and diastolic dysfunction, often due to myocardial fibrosis.
- Antihypertensive medications can reverse these structural and functional cardiac alterations to varying extents.
Purpose of the Study:
- To investigate the hemodynamic effects of angiotensin-converting enzyme (ACE) inhibition at rest and during exercise in patients with essential hypertension.
- To assess the impact of ACE inhibitors on cardiac structure and function.
Main Methods:
- Hemodynamic parameters were measured in 68 patients with essential hypertension before and after ACE inhibition.
- Patients received intravenous perindoprilat or chronic oral treatment with captopril, enalapril, or lisinopril for 6-12 months.
Main Results:
- Intravenous perindoprilat reduced mean arterial pressure by ~17% in moderately severe hypertension, primarily by decreasing total peripheral resistance without altering heart pump function.
- Chronic ACE inhibitor treatment lowered blood pressure and peripheral resistance, with minimal changes in cardiac output, stroke volume, and heart rate.
Conclusions:
- ACE inhibitors demonstrate a promising cardioprotective effect by improving cardiac structure and function, including reversing left ventricular hypertrophy and enhancing diastolic function.
- Long-term clinical studies are necessary to confirm the practical benefits of ACE inhibitors for cardioprotection in hypertension management.
Abstract:
Hypertension frequently is associated with a number of changes in heart structure and function, such as left ventricular hypertrophy, disturbed diastolic function, and subnormal stroke volume during exercise. Most of these changes probably are related to myocardial fibrosis. Antihypertensive agents reverse the structural and functional changes to different degrees. The hemodynamic changes in central hemodynamics at rest and during exercise were studied before and after angiotensin-converting enzyme (ACE) inhibition in 68 patients with essential hypertension (ranging from severe to moderately severe). In patients with moderately severe hypertension who were administered perindoprilat intravenously, mean arterial pressure was reduced by approximately 17% due to reduction in total peripheral resistance and no changes in heart pump function. Chronic treatment with captopril, enalapril, or lisinopril for 6-12 months induced reduction in blood pressure associated with decreased peripheral resistance. In general, there were only minor changes in cardiac output, stroke volume, and heart rate. Studies from other laboratories have shown that ACE inhibitors reverse left ventricular hypertrophy and improve left ventricular diastolic function. Captopril also appears to improve coronary circulation. The effect of ACE inhibitors on heart structure and function appears promising with regard to cardioprotection during chronic use, but long-term studies are needed to prove that this will occur in clinical practice.