Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.15.1 (ACE)
 18,300 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of ACE-inhibitors has increased greatly during the last years. They were first used in treating hypertension, but nowadays cardiac diseases, mainly cardiac failure, are common indications. This means that the drugs are used in the treatment of more elderly patients who often have generalised atherosclerosis. This means that the patients must be controlled more often after initiation of treatment, especially concerning kidney function, since treatment with ACE-inhibitors can cause pronounced changes in renal haemodynamics and kidney function. This review focuses on the effects of ACE-inhibitors on renal haemodynamics and kidney function, which may be positive, with preservation of kidney function in diabetic and other chronic nephropathy, or negative, for example in cases with atherosclerotic stenosis of large or small renal arteries. It is concluded, that in cases of diabetic nephropathy an ACE-inhibitor is the "drug of choice" for treatment of hypertension. Furthermore the ACE-inhibitors seem to reduce the rate of deterioration of renal function and proteinuria in other kidney diseases. It is emphasized, that during treatment with ACE-inhibitors kidney function must be controlled before and following one to two weeks of treatment, if the dose is changed and in all cases following two to three months of treatment. Special attention should be given to patients with atherosclerotic manifestations e.g. angina.
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PMID:[Renal function during treatment with angiotensin converting enzyme inhibitors]. 748 49

Theoretically, it should be possible to match the requirements of individual patients with the pharmacological and clinical properties of the large number of antihypertensive drugs now available. The concept of automatic sequential stepped-care therapy is now largely outdated, but therapy of clinically important hypertension must be initiated with one agent. Diuretics remain a first-line option in the elderly and in Black patients, as do calcium antagonists. Outcome trials are available only for the elderly, and in these the benefits of initial diuretic therapy are well documented. Nonetheless, diuretics may often need to be co-prescribed with a beta-blocker or an adrenergic modifier such as methyldopa. beta-Blockers are preferred in patients with ischaemic heart disease or enhanced adrenergic drive, while alpha-blockers are preferred in patients with blood lipid abnormalities or prostatic problems. Calcium antagonists or angiotensin converting enzyme (ACE) inhibitors are being increasingly used as initial therapy when quality of life is important and metabolic neutrality is required. Calcium antagonists are more likely to be effective first-line therapy than ACE inhibitors in patients with a high salt intake, in patients with Raynaud's disease, when angina pectoris is present, and in Black patients. ACE inhibitors are preferred for combination with diuretic agents, and in the presence of congestive heart failure or low salt intake. Experimentally, both calcium antagonists and ACE inhibitors can prevent ischaemic ventricular fibrillation and atheroma. Combination therapy between these 2 drug classes is gaining increasing acceptance because of these theoretical advantages.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Individualised selection of antihypertensive therapy. 751 67

As in hypertension, the addition of a second active drug is believed to enhance treatment efficacy; however, the extent to which a combination of two low-dose drugs outperforms conventional monotherapy remains uncertain. Established treatments of angina comprises nitrates compounds, beta-blockers and calcium antagonists, which are often given in combination. Beta-blockers are major players in this field as they inhibit the tachycardia induced by nitrates and calcium antagonists; there is therefore a pathophysiological justification for their use in combination therapy, supported by repeated confirmation of positive clinical effect. The most widely chosen calcium antagonists are dihydropyridines; verapamil may impair conduction. However, it is not clear whether combination enhances the effects of the individual antianginal substances. Diuretics are for most clinicians the keystone treatment of heart failure; diuretics are often combined with other drugs, e.g. amiloride and spironolactone. The latter also have a beneficial effect on myocardial structure (myocardium/collagen ratio). ACE-inhibitors are of proven clinical efficacy, and, in addition, have a beneficial effect on survival. They combine well with diuretics: because the diuretic stimulates renin release, the ACE-inhibitor can be given at a lower dose (enhancement of effect). There are, however, certain drawbacks (hypotension, hyperkalemia with antialdosterones). The results of combining ACE-inhibitors with calcium antagonists and beta-blockers await investigation. The ISIS studies demonstrated the advantages of combining beta-blockers, thrombolysis and aspirin in acute infarction. ACE-inhibitors have recently been added to the regimen with a positive effect (extended survival), especially in the presence of a decreased ejection fraction (SAVE, AIRE, GISSI 3 and ISIS 4 studies).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Combination therapy in cardiovascular diseases other than hypertension]. 767 73

Heart failure is a major and increasing public health problem. Coronary artery disease has become the major etiology of heart failure. The differentiation of viable from nonviable myocardium in patients with coronary disease and impaired left ventricular systolic function is an issue of extreme importance to the clinician. Several diagnostic modalities including thallium imaging, dobutamine stress echocardiography, and positron emission tomography have gained considerable acceptance as useful tools in detecting myocardial viability. The management of heart failure with preserved left ventricular systolic function includes the use of beta blockers, calcium channel blockers, and nitrates. In patients with heart failure and impaired left ventricular systolic function, angiotensin converting enzyme inhibitors have become an integral part of the medical management. In patients whose angina is unresponsive to the addition of nitrates, a trial of bet blockers should be attempted and first generation calcium blockers should be avoided. Revascularization should always be sought, particularly when myocardial viability has been established.
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PMID:Ischemic heart failure. 778 74

The treatment of microvascular angina (anginal pain resulting from myocardial ischemia due to dysfunction of small coronary arteries) is empiric and often ineffective at present. The poor knowledge of the pathophysiologic mechanisms responsible for the microvascular dysfunction and the possible heterogeneous nature of the disease limit the possibility of a rational therapeutic approach to these patients. The failure of traditional antiischemic therapy is confirmed by the frequent unresponsiveness of angina and by the reduced exercise tolerance with administration of sublingual nitrates. Despite that, beta-blockers and calcium-antagonists, when given either alone or in combination, are beneficial in the control of symptoms in some patients. Alternative forms of treatment, based on some pathophysiological hypotheses and clinical observations, include xanthine derivatives, ACE-inhibitors, alpha-blocking agents, imipramine and, in women, oestrogens. The actual clinical usefulness of these drugs, however, is questionable at present, as their efficacy should be evaluated with more adequate studies in the future.
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PMID:[Therapy of microvascular angina]. 791 50

Secondary cardioprotection of patients with angina pectoris can be accomplished by selecting appropriate drugs for the specific clinical setting. Calcium-antagonists are the first choice drugs in patients with vasospastic angina or in those clinical situations in which vasoconstriction plays a significant pathogenetic role. On the contrary beta-blockers reduce mortality and the probability of myocardial infarction in patients with unstable angina. The beneficial effects of aspirin on survival of patients with unstable angina is also well known, whereas ACE-inhibitors reduce mortality as well as the incidence of unstable angina in patients with ischemic cardiomyopathy. Also nonpharmacologic treatments (physical exercise, preconditioning) may have beneficial effects although their role is not well established yet.
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PMID:[Myocardial protection in the patient with angina: bases for a personalized treatment]. 791 54

There is now little dispute that clinical tolerance of organic nitrates occurs, particularly when these drugs are used by themselves to treat patients with stable angina pectoris and congestive heart failure. Classical hypotheses of nitrate tolerance suggest the phenomenon to result from vascular depletion of critical sulfhydryl groups, which are necessary to bring about vasorelaxation from nitrates. While this mechanism of nitrate tolerance probably operates when isolated blood vessels are exposed to high concentrations of nitrate in vitro, there is little evidence to suggest that it contributes to clinical nitrate tolerance. Instead, emerging data suggest that nitrates can cause significant shifts in fluid distribution and secretion of neurohormonal factors that can modulate their vasorelaxant effects. Use of angiotensin converting enzyme inhibitors and diuretics in conjunction with nitrates may alleviate the development of tolerance, but the experience has not been universally favorable. Other receptor-effector systems that affect cardiovascular function, such as the adrenergic system, may also be affected by nitrate tolerance. The mechanisms of nitrate tolerance are therefore likely to be multifactorial, involving vascular biochemical changes, physiologic compensation, and possibly receptor regulation.
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PMID:Mechanisms of nitrate tolerance. 794 66

We have evaluated the effect of enalapril in the prevention of restenosis after percutaneous transluminal coronary angioplasty by a randomized trial conducted on 95 patients. The treatment group (n = 46) received enalapril 10 mg/day besides aspirin with calcium blockers, beginning 24 hours before coronary angioplasty. The conventional medical treatment group (n = 49) received only aspirin and calcium blockers. Enrollment required the presence of angina pectoris and successful dilatation of all significant coronary narrowings. All patients were followed up for at least 6 months. Restenosis was identified by symptoms and exercise testing and confirmed by angiography. The incidence of angiographic restenosis was 34% in the enalapril group and 31% in the conventional treatment group. Long term angiotensin converting enzyme inhibition with enalapril in a dose of 10 mg per day does not prevent restenosis after coronary angioplasty.
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PMID:Enalapril for prevention of restenosis after coronary angioplasty. 807 Aug 23

The rationale, design, organization and outcome definitions of the Survival of Myocardial Infarction Long-term Evaluation (SMILE) study are described in detail. The recruitment of a total of 1500 patients (750 per treatment group) has been planned for this multicenter, double-blind, randomized, placebo-controlled study to investigate the effects of oral treatment with zofenopril calcium (7.5-30 mg twice a day) on the combined short-term total mortality and occurrence of severe refractory congestive heart failure in patients with acute anterior myocardial infarction (AMI). Secondary end-points of the study include recurrent myocardial infarction, angina, progression of congestive heart failure as well as long-term mortality. Patients are initially treated in hospital within 24 hours from the onset of symptoms of AMI and their active follow-up continued for 6 weeks. In addition, the patients will be passively followed for a total of 12 months from the index AMI to assess their vital status and the occurrence of congestive heart failure. The study data will be analyzed on an intention to treat basis. An international independent Policy and Safety Monitoring Board is acting as the overall supervisory body and is responsible for the ethical conduction of the trial. A Scientific Committee is responsible for the scientific aspects of the trial and for the regular review of the progress of the study. We assume that the rationale and design of the SMILE trial will provide reliable information on the ability of ACE-inhibitors to reduce the occurrence of major cardiovascular events in patients with acute myocardial infarction.
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PMID:[The SMILE study: the rationale, design, organization and definition of the objectives. Survival of Myocardial Infarction Long-term Evaluation]. 816 79

Chronic heart failure (CHF) is common, disabling and deadly. Recent studies show that ACE inhibitors reduce morbidity and mortality in all grades of CHF and may even delay or prevent the onset of overt CHF in patients with asymptomatic left ventricular dysfunction. In this review, guidelines are given for how to use these drugs both in hospital and in general practice. New evidence on the benefits of digoxin is also considered, and the management of concomitant problems such as angina and arrhythmias in patients with CHF is discussed.
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PMID:Problems solved and lives saved? Chronic heart failure. 817 79


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