Zusammenfassung
Die Wirkung einer medikamentösen ACE-Hemmung besteht in einer verminderten Bildung von Angiotensin II aus Angiotensin I. An dieser Bildung sind allerdings auch andere Enzymsysteme beteiligt. Ebenfalls gehemmt wird der Abbau von Bradykinin. Angiotensin II wirkt stark vasokonstringierend im arteriellen, aber auch im venösen System. Es führt zu einer vermehrten Freisetzung von Aldosteron und Catecholaminen. Nachgewiesen wurden außerdem trophische Effekte in Zellkulturen, die Bedeutung für die vaskulären und kardialen Veränderungen bei Hochdruck- und Nierenkrankheiten haben. Nachdem oral wirksame Angiotensinrezeptorantagonisten entwickelt wurden, hatte sich gezeigt, daß die Rezeptoren für Angiotensin II in mindestens zwei Gruppen, AT1- und AT2-Rezeptoren, mit teilweise gegensätzlichen Effekten gegliedert werden müssen. Die antihypertensive Wirkung erfolgt über AT1-Rezeptorblockade, während der AT2-Rezeptor weiterhin der Wirkung des Angiotensins ausgesetzt ist. Dies und der nicht gehemmte Abbau von Bradykinin gestatten nicht die ungeprüfte Annahme einer gleichen klinischen Wirksamkeit von ACE-Hemmern und Angiotensinrezeptorantagonisten oder gar die voreilige Behauptung, Angiotensinrezeptorantagonisten seien lediglich besser verträgliche ACE-Hemmer.
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Literatur
CONSENSUS Trial Study Group (1987): Effects of enalapril on mortality in severe congestive heart failure: Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). New Engl. J. Med. 316:1429–1435.
Dahlof B., Devereux R.B., Julius S., Kjeldsen S.E., Beevers G., de Faire U. et al. (1998): Characteristics of 9194 patients with left ventricular hypertrophy: the LIFE study. Losartan Intervention For Endpoint Reduction in Hypertension. Hypertension 32: 989–997.
Fiather M.D., Yusuf S., Kober L., Pfeffer M. et al. (2000): Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. Lancet 355:1575–1581.
Hall A.S., Murray G.D., Ball S.G. (AIREX Study Group Investigators) (1997): Follow-up study of patients randomly allocated ramipril or placebo for heart failure after myocardial infarction: AIRE extension (AIREX) study. Lancet 349: 1493–1497.
Hansson L., Lindholm L.H., Niskanen L., Lanke J., Hedner T., Niklason A., Luomanmaki K., Dahlof B., de Faire U., Morlin C., Karlberg B.E., Wester P.O., Bjorck J.E. (1999): Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 353: 611–616.
Heart Failure Society of America (HFSA) practice guidelines (1999): HFSA guidelines for management of patients with heart failure caused by left ventricular systolic dysfunction - pharmacological approaches. J. Card. Fail. 5: 357–382.
ISIS-4 Collaborative Group (1995): ISIS-4: a randomised factorial trial assessing early oral captopril, oral mononitrate and intravenous magnesium sulphate in 58050 patients with suspected acute myocardial infarction. Lancet 345:669– 685.
Israili Z.H., Hall W.D. (1992): Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology. Ann. Intern. Med. 117: 234–242.
Kasiske B.L., Kalili R.S.N., Ma J.Z., Liao M., Keane W.F. (1993): Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis. Ann. Intern. Med. 118: 129–138.
Lewis E.J., Hunsicker L.G., Bain R.P., Rohde R.D. for the Collaborative Study Group (1993): The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N. Engl. J. Med. 329: 1456–1462.
Mann J.F., Gerstein H.C., Pogue J., Bosch J., Yusuf S. (2001): Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann. Intern. Med. 134: 629–636.
Maschio G., Albert D., Ganin G., Locatelli F., Mann J.F.E. et al. (1996): Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N. Engl. J. Med. 334: 939–945.
Morgensen C.E., Neldam S., Tikkanen I., Oren S., Viskoper R., Watts R.W., Cooper M.E. (2000): Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the Candesartan And Lisinopril Microalbuminuria (CALM) Study. Brit. Med. J. 321:1440–1444.
Neal B., MacMahon S., Chapman N. for the Blood Pressure Lowering Treatment Trialists’ Collaboration (2000): Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Lancet 356:1955–1964.
Pitt B., Segal R., Martinez F.A., Meurers G., Cowley A.J. et al. (Elite study investigators) (1997): Randomized trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of the losartan in the elderly study, ELITE). Lancet 349: 747–752.
Pitt B., Poole-Wilson P.A., Segal R., Martinez F.A. et al. (2000): Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial - the Losartan Heart Failure Survival Study ELITE II. Lancet 355: 1582–1587.
The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators (1993): Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 342: 821–828.
The EUCLID Study Group (1997): Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbu-minuria or microalbuminuria. Lancet 349: 1787–1792.
The GISEN Group (1997): Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 349: 1857–1863.
The Heart Outcomes Prevention Evaluation (HOPE) Study Investigators (2000a): Effects of an angiotensin-converting-enzyme inhibitor, Ramipril, on cardiovascular events in high-risk patients. N. Engl. J. Med. 342:145–153.
The Heart Outcomes Prevention Evaluation (HOPE) Study Investigators (2000b): Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 355: 253–259.
UK Prospective Diabetes Study Group (1998): Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Brit. Med. J. 317: 713–720.
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Anlauf, M. (2001). ACE-Hemmer und Angiotensinrezeptorantagonisten. In: Schwabe, U., Paffrath, D. (eds) Arzneiverordnungs-Report 2001. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56434-5_3
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DOI: https://doi.org/10.1007/978-3-642-56434-5_3
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