Encyclopedia of Heart Diseases

2011 Edition
| Editors: M. Gabriel Khan

ACE Inhibitors/Angiotensin Receptor Blockers

Reference work entry
DOI: https://doi.org/10.1007/978-1-60761-219-3_2

Overview

Since their introduction in 1980, angiotensin-converting enzyme (  ACE) inhibitors, because of their unique pharmacologic properties, have proven superior to other vasodilators in the management of  heart failure and have come to play a key role in the therapy of hypertension. They are particularly useful in hypertensive patients with diabetes and  proteinuria and provide significant cardiovascular disease (CVD) protection. Angiotensin receptor blockers (ARBs) have the same clinical indications and are advisable when intolerance to ACE inhibitor therapy occurs. Their only advantages over ACE inhibitors are a much lower incidence of cough and angioedema; but a possibility remains that they may not possess equal beneficial effects, particularly on clinical outcomes despite the favorable results observed in some randomized clinical trials (RCTs).
  • The angiotensin receptor blocker telmisartan failed to prevent stroke in a well-run stroke RCT (PRoFESS 2008). In the large RCT...

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Bibliography

References

  1. ACE Inhibitor Myocardial Infarction Collaborative Group (1998) Indications for ACE inhibitors in the early treatment of acute myocardial infarction. Systematic overview of individual data from 100,000 patients in randomized trials. Circulation 97:2202–2212Google Scholar
  2. Bach DS (2009) Angiotensin-converting enzyme inhibitor therapy at the time of coronary artery bypass surgery when a friend turns mean-spirited. J Am Coll Cardiol 54(19):1785–1786PubMedGoogle Scholar
  3. Davis JO, Freeman RH (1976) Mechanisms regulating renin release. Physiol Rev 56:1PubMedGoogle Scholar
  4. Ganong WF (1984) The brain renin-angiotensin system. Annu Rev Physiol 46:17PubMedGoogle Scholar
  5. Khan M Gabriel (2007) ACE inhibitor Controversies in Cardiac drug therapy, 7th edn. Humana Press, New York, p 64Google Scholar
  6. Miceli A, Capoun R, Fino C et al (2009) Effects of angiotensin-converting enzyme inhibitor therapy on clinical outcome in patients undergoing coronary artery bypass grafting. J Am Coll Cardiol 54:177–184Google Scholar
  7. Nathan DM (2010) Navigating the Choices for Diabetes Prevention. NEJM 362:1533–1535PubMedGoogle Scholar
  8. Parving H-H, Lenhert H, Brochner-Mortensen J et al for the Irbesartan in Patients with Type II Diabetes and Microalbuminuria Study Group (2001) The effect of irbesartan on the development of diabetic nephropathy in patients with type II diabetes. N Engl J Med 345:870Google Scholar
  9. Pitt B, Poole-Wilson PA, Segal R et al (2000) Effect of losartan compared with captopril on mortality on patients with symptomatic heart failure: randomized trial. The Losartan Heart Failure Study. Lancet 255:1582. ELITE IIGoogle Scholar
  10. Staessen JA, Richart T, Wang Z et al (2010) Implications of recently published trials of blood pressure-lowering drugs in hypertensive or high-risk patients. Hypertension 55:819–831PubMedGoogle Scholar
  11. The European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease Investigators (2003) Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomized, double-blind, placebo-controlled, multicenter trial. Lancet 362:782–788. EUROPAGoogle Scholar
  12. Weinsaft JW (2000) Effect of ramipril on cardiovascular events in high-risk patients. N Engl J Med 343:64–66PubMedGoogle Scholar

Suggested Reading

  1. Belluzzi F, Sernesi L, Preti P et al (2009) Prevention of recurrent lone atrial fibrillation by the angiotensin-II converting enzyme inhibitor ramipril in normotensive patients. J Am Coll Cardiol 53:24–29PubMedGoogle Scholar
  2. Pitt B (2009) RAAS inhibition/blockade in patients with cardiovascular disease: implications of recent large-scale randomised trials for clinical practice. Heart 95:1205–1208PubMedGoogle Scholar
  3. Strauss MH, Hall A (2009) Angiotensin receptor blockers should be regarded as first-line drugs for stroke prevention in both primary and secondary prevention settings: No. Stroke 40:3161–3162PubMedGoogle Scholar
  4. The NAVIGATOR Study Group (2010a) Effect of nateglinide on the incidence of diabetes and cardiovascular events. N Engl J Med 362:1463–1476 (Free Full Text)Google Scholar

Case Studies

  1. Acute Infarction Ramipril Efficacy 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. AIREGoogle Scholar
  2. Ambrosioni E, Borghi C, Magnani B et al for the Survival of Myocardial Infarction Long-term Evaluation Study Investigators (1995) The effect of the angiotensin-converting enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction. N Engl J Med, 332:80. SMILEPubMedGoogle Scholar
  3. CONSENSUS Trial Study Group (1987) Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study. N Engl J Med 316:1429. CONSENSUSGoogle Scholar
  4. Granger CB, McMurray JJV, Yusuf S et al for the CHARM Investigators and Committees (2003) Effects of candesartan in patients with chronic heart failure and reduced left ventricular systolic function intolerant to angiotensin converting enzyme inhibitors. Lancet 362:772–776. CHARM-alternative trialGoogle Scholar
  5. Hanley AJ, Zinman B, Sheridan P et al (2010) Effect of rosiglitazone and ramipril on β-cell function in people with impaired glucose tolerance or impaired fasting glucose. Diabetes Care 33:608–613PubMedGoogle Scholar
  6. ONTARGET Investigators (31 March 2008) Telmisartan, ramipril, or both in patients at high risk for vascular events. N Eng J Med. Published at www.nejm.org. ONTARGET
  7. Pfeffer MA, Braunwald E, Moye LA et al for the SAVE Investigators (1992) Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. N Engl J Med 327:669. SAVEPubMedGoogle Scholar
  8. SOLVD Investigators (1991) Effect of enalapril on survival in patients with reduced ventricular ejection fractions and congestive heart failure. N Engl J Med 325:293. SOLVDGoogle Scholar
  9. The DREAM Trial Investigators (2006) Effect of ramipril on the incidence of diabetes. N Engl J Med 355:1551–1562. DREAMGoogle Scholar
  10. The NAVIGATOR Study Group (2010b) Effect of valsartan on the incidence of diabetes and cardiovascular events. N Engl J Med 362:1477–1490. NAVIGATORGoogle Scholar
  11. The PEACE Trial Investigators (2004) Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med 351:2058–2068. PEACEGoogle Scholar
  12. Yusuf S, Sleight P, Progue J et al (2000) Effects of angiotensin converting enzyme inhibitor, ramipril, on death from cardiovascular causes, myocardial infarction, and stroke in high-risk patients. N Engl J Med 342:145. HOPEPubMedGoogle Scholar
  13. Yusuf S, Diener H-C, Sacco RL et al (2008a) Telmisartan to prevent recurrent stroke and cardiovascular events. N Eng J Med 359(12):1225–1237. PRoFESSGoogle Scholar
  14. Yusuf S, Teo K, Anderson C et al for the TRANSCEND Investigators (2008b) Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. Lancet 372:1174–1183. TRANSCENDPubMedGoogle Scholar

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