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[Enzyme converting inhibitors. Current knowledge and perspectives]
1Service de Cardiologie, Hôpital Intercommunal, Poissy.
Insights
Angiotensin converting enzyme inhibitors (CEI) effectively treat hypertension and heart failure by lowering resistance. Early use after myocardial infarction significantly reduces mortality, with benefits persisting even after discontinuation.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Pharmacology
Context:
- Hypertension and heart failure are major cardiovascular diseases.
- Myocardial infarction (MI) and diabetic nephropathy are serious conditions.
- The renin-angiotensin system plays a role in cardiovascular and renal health.
Purpose:
- To review the therapeutic applications of angiotensin converting enzyme inhibitors (CEI).
- To highlight the benefits of CEI in post-MI patients and those with diabetic nephropathy.
- To explore the potential of CEI in managing atherosclerosis.
Summary:
- CEI reduce arteriolar resistance, making them logical treatments for hypertension and heart failure.
- Early administration of CEI post-MI significantly reduces mortality, an effect additive to other therapies.
- CEI slow renal failure progression in insulin-dependent diabetes and may inhibit atherosclerosis.
Impact:
- CEI offer substantial mortality reduction in post-MI patients.
- CEI are crucial in managing macroproteinuric nephropathy in diabetics.
- Further research is exploring CEI's role in non-insulin-dependent diabetes and atherosclerosis.
Abstract:
Angiotensin converting enzyme inhibitors (CEI) are logically proposed for the treatment of hypertension and heart failure because of their effect on reducing arteriol resistance. When administered early after myocardial infarction, CEI reduce mortality, particularly patients with severely deteriorated myocardium. Up to 74 lives can be saved for every 1000 patients treated. This beneficial effect is additive with that resulting from aspirin, beta-blockers and fibrinolysis. The effect occurs within the first month of treatment if initiated within the first 24 hours following the infarction, and persists even if treatment is discontinued. Tolerance is generally good, but dosage must be adapted in case of hypotension or temporary renal failure. Macroproteinuric nephropathy in insulin-dependent-diabetes is another indication for CEI. Captopril and enalapril have been shown to slow progression of renal failure and decrease the risk of death and of chronic dialysis. Further studies are being conducted to determine the effect of CEI in non-insulin-dependent diabetes. Finally, experimental arguments suggest that atherosclerosis is partly dependent on the renin/angiotensin system and that CEI might inhibit its development. Most clinical trials evaluating the action of CEI on atheromatosis have studied the effect in the carotid and coronary arteries.