Ace Inhibitor
Not to be confused with Acetylcholinesterase inhibitor. An angiotensin-converting-enzyme inhibitor (ACE inhibitor) is a pharmaceutical drug used primarily for the treatment of hypertension (elevated blood pressure) and congestive heart failure. This group of drugs causes relaxation of blood vessels as well as a decrease in blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart. They inhibit the angiotensin-converting enzyme, an important component of the renin–angiotensin system. Frequently prescribed ACE inhibitors include benazepril, zofenopril, perindopril, trandolapril, captopril, enalapril, lisinopril, and ramipril. Medical use[edit] ACE inhibitors were initially approved for the treatment of hypertension and can be used alone or in combination with other antihypertensive medications. Later, they were found useful for other cardiovascular and kidney diseases[1] including: Acute myocardial infarction (heart attack) Cardiac failure (left ventricular systolic dysfunction) Kidney complications of diabetes mellitus (diabetic nephropathy) In treating heart disease, ACE inhibitors are usually used with other medications. A typical treatment plan often includes an ACE inhibitor, a beta blocker, a long-acting nitrate, and a calcium channel blocker, in combinations that are adjusted to the individual patient's needs. There are fixed-dose combination drugs, such as ACE inhibitor and thiazide combinations. ACE inhibitors have also been used in chronic kidney failure and kidney involvement in systemic sclerosis (hardening of tissues, as scleroderma renal crisis). In those with stable coronary artery disease, but no heart failure, benefits are similar to other usual treatments.[2] Other[edit] ACE inhibitors may also be used to help decreas Continue reading >>
Should All Patients With Type 1 Diabetes Mellitus And Microalbuminuria Receive Angiotensin-converting Enzyme Inhibitors?: A Meta-analysis Of Individual Patient Data
Studies were identified by searching MEDLINE and related bibliographies. Selected studies included at least 10 normotensive patients with type 1 diabetes mellitus and microalbuminuria, had a placebo or nonintervention group, and included at least 1 year of follow-up. Raw data were obtained for 698 patients from the 12 identified trials. Analysis of treatment effect at 2 years was restricted to trials with at least 2 years of follow-up (646 patients from 10 trials). In patients receiving ACE inhibitors, progression to macroalbuminuria was reduced (odds ratio, 0.38 [95% CI, 0.25 to 0.57]) and the odds ratio for regression to normoalbuminuria was 3.07 (CI, 2.15 to 4.44). At 2 years, albumin excretion rate was 50.5% (CI, 29.2% to 65.5%) lower in treated patients than in those receiving placebo (P<0.001). Estimated treatment effect varied by baseline albumin excretion rate (74.1% and 17.8% in patients with a rate of 200 g/min and 20 g/min, respectively [P=0.04]) but not by patient subgroup. Adjustment for change in blood pressure attenuated the treatment difference in albumin excretion rate at 2 years to 45.1% (CI, 18.6% to 63.1%; P<0.001). In normotensive patients with type 1 diabetes mellitus and microalbuminuria, ACE inhibitors significantly reduced progression to macroalbuminuria and increased chances of regression. Beneficial effects were weaker at the lowest levels of microalbuminuria but did not differ according to other baseline risk factors. Changes in blood pressure cannot entirely explain the antiproteinuric effect of ACE inhibitors. *For members of the ACE Inhibitors in Diabetic Nephropathy Trialist Group, see Appendix . Continue reading >>
Using Ace Inhibitors Appropriately
When first introduced in 1981, angiotensin-converting enzyme (ACE) inhibitors were indicated only for treatment of refractory hypertension. Since then, they have been shown to reduce morbidity or mortality in congestive heart failure, myocardial infarction, diabetes mellitus, chronic renal insufficiency, and atherosclerotic cardiovascular disease. Pathologies underlying these conditions are, in part, attributable to the renin-angiotensin-aldosterone system. Angiotensin II contributes to endothelial dysfunction, altered renal hemodynamics, and vascular and cardiac hypertrophy. ACE inhibitors attenuate these effects. Clinical outcomes of ACE inhibition include decreases in myocardial infarction (fatal and non-fatal), reinfarction, angina, stroke, end-stage renal disease, and morbidity and mortality associated with heart failure. ACE inhibitors are generally well tolerated and have few contraindications. Cardiovascular disease affects one in four Americans. According to the American Heart Association, heart and related diseases are expected to cost Americans more than $329 billion in 2002. An estimated 10 million persons in this country are known to have diabetes and 3.6 million to have renal disease, incurring annual health care costs of $98 billion and $11 billion, respectively. Although angiotensin-converting enzyme (ACE) inhibitors have documented clinical benefits in a variety of clinical situations, the disparity between the evidence from clinical trials and bedside medicine is well documented. The National Registry of Myocardial Infarction 2 found that fewer than one half of patients surviving acute myocardial infarction who were candidates for therapy with ACE inhibitors received these life-saving drugs at discharge.1 A recent review of patients with asymptomatic l Continue reading >>
Role Of Ace Inhibitors In Treating Hypertensive Diabetic Patients
, Volume 2, Issue3 , pp 251257 | Cite as Role of ACE Inhibitors in treating hypertensive diabetic patients Cardiovascular disease (CVD) is a major determining factor of morbidity and mortality in type 2 diabetic patients. Hypertension, which accompanies diabetes in more than 70% of cases, contributes to increased prevalence of CVD events in this group of patients. Results from the United Kingdom Prospective Diabetes Study (UKPDS) indicated that reduction of elevated blood pressure might decrease CVD morbidity and mortality more than reduction of hyperglycemia. Activation of circulating and tissue renin-angiotensin system (RAS) contributes to the development of both hypertension and insulin resistance in patients with the cardiometabolic syndrome. Angiotensin-converting enzyme (ACE) inhibitor therapy in patients with the cardio-metabolic syndrome may improve insulin action as well as lessen CVD. In clinical trials, ACE inhibitors have been shown to be more efficient than other antihypertensive medications (ie, calcium channel blockers) in the reduction of CVD morbidity and mortality in hypertensive diabetics. In this article, we summarize possible mechanisms by which ACE inhibition may improve insulin resistance, coagulation/ clotting, and vascular function abnormalities, and postpone or even prevent the development of type 2 diabetes in hypertensive patients. RamiprilFosinoprilUnited Kingdom Prospective Diabetes StudyImidaprilHypertension Optimal Treatment These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. This is a preview of subscription content, log in to check access Unable to display preview. Download preview PDF. Sowers JR, Epstein M, Frohlich ED: Hypertensi Continue reading >>
Ace Inhibitors Improve Diabetic Nephropathy Through Suppression Of Renal Mcp-1
OBJECTIVE—Chemokines play an important role in the pathogenesis of diabetic nephropathy. Angiotensin II induces several fibrogenic chemokines, namely monocyte chemoattractant protein-1 (MCP-1) and transforming growth factor-β. The progression of diabetic nephropathy can be retarded by ACE inhibitors (ACEIs) in patients with type 1 and type 2 diabetes. We examined if blockade of the renin-angiotensin system lowered urinary levels of the chemokine MCP-1 and correlated urinary MCP-1 (uMCP-1) with parameters of renal function and glucose and lipid metabolism before and after 1 year of treatment with an ACE inhibitor. RESEARCH DESIGN AND METHODS—In 22 patients with type 2 diabetes and diabetic nephropathy in stages 3–5, treatment with the ACEI lisinopril was initiated. Before treatment and after 12 months of continuous therapy, proteinuria, creatinine clearance, uMCP-1 levels, BMI, HbA1c, and serum cholesterol were assessed. RESULTS—Lisinopril treatment improved renal function. Proteinuria decreased from 410 ± 662 mg per 24 h to 270 ± 389 mg per 24 h. Creatinine clearance rose from 61 ± 26 to 77 ± 41 ml/min. Urinary MCP-1 levels decreased from 0.456 ± 0.22 ng/mg creatinine to 0.08 ± 0.096 ng/mg creatinine. The change in uMCP-1 correlated significantly (r = 0.61, P < 0.001) with the change in proteinuria. No other parameter correlated with the improvement in renal function. CONCLUSIONS—Blockade of the renin-angiotensin system in type 2 diabetic patients with diabetic nephropathy reduces uMCP-1 levels and improves renal function. Because MCP-1 induces monocyte immigration and differentiation to macrophages, which augment extracellular matrix production and tubulointerstitial fibrosis, pharmacological reduction of angiotensin II may also exert its beneficial ef Continue reading >>
Ace Inhibitors Top Choice For Hypertension In Diabetes
ACE Inhibitors Top Choice for Hypertension in Diabetes As recommended in guidelines, angiotensin-converting enzyme (ACE) inhibitors should be the first-line treatment in patients with hypertension who have diabetes mellitus (DM) when cost is not a concern, according to a new study. In addition, the authors suggest that calcium channel blockers might be the preferred treatment in combination with ACE inhibitors if adequate blood pressure control cannot be achieved by ACE inhibitors alone. Among patients with DM, ACE inhibitors fared better than placebo in reducing creatinine doubling, and beta-blockers were associated with an increased risk of death. In addition, ACE inhibitors in combination with other antihypertension medications did not show significant protective effects compared with placebo, but the likelihood of lowering mortality in patients was greater. Guidelines suggest ACE inhibitors or angiotensin receptor blockers (ARBs) should be the first-line treatment in in patients with hypertension who have DM when cost is not a concern. Clinical trials comparing an ACE inhibitor with an ARB are rare, and the difference in protective effects between these drugs for patients with DM remains inconclusive. No consensus exists about the choice of treatments in combination with renin-angiotensin system blockers in patients with DM, state lead author Hon-Yen Wu and colleagues from National Taiwan University Hospital and College of Medicine, Taipei, Taiwan. By combining direct and indirect evidence, our analyses show the renoprotective effects and superiority of ACE inhibitors in patients with diabetes, and also show the harmful effects of beta-blockers, the authors state. As the available evidence is not able to show a better protective effect for ARBs compared with ACE in Continue reading >>
Acei In Diabetes Mellitus
The role of ACE inhibitors in patients with diabetics has been investigated in the studies such as the: the HOPE study (n=9,297, 38% with diabetes) provided evidence that ramipril significantly reduced the risk of MI, stroke or cardiovascular death compared with placebo over five years (14.0% vs. 17.8%; NNT 27) - benefits were especially evident in the subgroup of patients with diabetes it has been suggested that these effects of ramipril are beyond those that could be expected from its BP lowering properties - however, this has been disputed by meta-analyses that suggest, for most cardiovascular outcomes, BP lowering effects account for the majority of the benefits seen with different antihypertensives (1) ACE inhibitors slow the progression of renal disease in type I diabetes independent of the effects of blood pressure. There is mounting evidence that the same is true in type II diabetes. The benefits of treatment with ACE inhibitors may result from reducing proteinuria and reducing blood pressure (these effects are not specific to ACE inhibitors) and via direct effects of angiotensin II on glomerular haemodynamics, inflammation, slcerosis and fibrosis (3). Note it has been suggested that thiazide diuretics should be the first-line treatment for diabetic patients with hypertension based on study evidence such as ALLHAT (2) (see linked item): "..Thiazide diuretics are a suitable first choice in people with type 2 diabetes. ACE inhibitors are a reasonable alternative to a thiazide if these are unsuitable, or addition to a thiazide if further BP lowering is required. ACE inhibitors should be used first-line in people with type 2 diabetes if they have renal disease..." A meta-analysis of the use of angiotensin receptor blockers as antihypertensive treatment for patients Continue reading >>
The Use Of Ace Inhibitors
The Kidneys and Diabetes Back to Related Health Issues ACE inhibitors, are drugs normally used for the treatment of high blood pressure. This is a category of drugs called Angio-Converting Enzyme inhibitors – ACE for short. ACE is an enzyme found in our bodies which activates a hormone called angiotensin causing the blood vessels to constrict, so raising blood pressure and putting pressure on the heart. ACE inhibitors prevent the action of angiotensin resulting in a lowering of blood pressure. However, there is evidence that the use of ACE inhibitors in people who start to show small amounts of protein in the urine, helps to reduce the progression to macroalbuminuria. In other words the use of ACE inhibitors has a protective effect on the kidneys, even in people whose blood pressure is normal. What does the research show? A meta-analysis [Ann Intern Med 2001 March ; 134[5] 370-9] was published on this subject. This is an analysis of studies to provide better evidence than just looking at individual studies. In this case, the studies were selected on the following basis: They included at least 10 people with Type 1 diabetes who had microalbuminuria and normal blood pressure. They had a control group who were not treated with ACE inhibitors [placebo group] They had follow up results at least a year later. 12 studies were selected with a total of 698 patients. The results showed: The progression to macroalbuminuria was reduced in patients receiving ACE inhibitors. After two years the albumin excretion rate was 50.5% lower in treated patients than in those receiving a placebo [no treatment]. For patients with normal blood pressure, Type 1 diabetes and microabluminuria, ACE inhibitors significantly reduced progression to macroalbuminuria and also increased the chances of r Continue reading >>
Effects Of Ras Inhibitors On Diabetic Retinopathy: A Systematic Review And Meta-analysis
Summary Results of several studies have shown a possible beneficial effect of renin-angiotensin system (RAS) inhibitors on diabetic retinopathy, but the findings were contradictory. We did a systematic review and meta-analysis to assess the effect of RAS inhibitors on diabetic retinopathy. We identified relevant publications in PubMed, Embase, Cochrane Library Central Register of Controlled Trials, and abstracts from main annual meetings. Only randomised controlled trials comparing angiotensin-converting enzyme (ACE) inhibitor or angiotensin-receptor blocker (ARB) monotherapy with other antihypertensive drugs or placebo in type 1 or type 2 diabetes were eligible for inclusion in the analysis. The primary outcomes were progression and regression of diabetic retinopathy in all patients and several subgroups. Risk ratios (RRs) with corresponding 95% CIs were pooled. We also did a network meta-analysis to assess the effect of different antihypertensive drugs on diabetic retinopathy by ranking order. This study is registered with the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42013004548. 21 randomised clinical trials with 13 823 participants were included in the meta-analysis. RAS inhibitors were associated with reduced risk of progression (absolute risk difference −3%, 95% CI −5 to −1; pooled RR 0·87, 95% CI 0·80–0·95; p=0·002) and increased possibility of regression of diabetic retinopathy (8%, 1–16; RR 1·39, 95% CI 1·19–1·61; p=0·00002). In normotensive patients, RAS inhibitors decreased risk of diabetic retinopathy progression (0·81, 0·69–0·94; p=0·007) and increased possibility of regression (1·43, 1·14–1·79; p=0·002). In hypertensive patients, RAS inhibitors were not associated with difference in risk Continue reading >>
- Effects of resveratrol on glucose control and insulin sensitivity in subjects with type 2 diabetes: systematic review and meta-analysis
- Effects of resveratrol on glucose control and insulin sensitivity in subjects with type 2 diabetes: systematic review and meta-analysis
- Effects of Insulin Plus Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs) in Treating Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis
Should All Patients With Type 1 Diabetes Mellitus And Microalbuminuria Receive Angiotensin-converting Enzyme Inhibitors?: A Meta-analysis Of Individual Patient Data
Purpose: To determine whether response of albumin excretion rate to angiotensin-converting enzyme (ACE) inhibitors has a threshold in patients with type 1 diabetes mellitus and microalbuminuria and to examine treatment effect according to covariates. Study Selection: Selected studies included at least 10 normotensive patients with type 1 diabetes mellitus and microalbuminuria, had a placebo or nonintervention group, and included at least 1 year of follow-up. Data Extraction: Raw data were obtained for 698 patients from the 12 identified trials. Analysis of treatment effect at 2 years was restricted to trials with at least 2 years of follow-up (646 patients from 10 trials). Data Synthesis: In patients receiving ACE inhibitors, progression to macroalbuminuria was reduced (odds ratio, 0.38 [95% CI, 0.25 to 0.57]) and the odds ratio for regression to normoalbuminuria was 3.07 (CI, 2.15 to 4.44). At 2 years, albumin excretion rate was 50.5% (CI, 29.2% to 65.5%) lower in treated patients than in those receiving placebo (P�<�0.001). Estimated treatment effect varied by baseline albumin excretion rate (74.1% and 17.8% in patients with a rate of 200 µg/min and 20 µg/min, respectively [P�=�0.04]) but not by patient subgroup. Adjustment for change in blood pressure attenuated the treatment difference in albumin excretion rate at 2 years to 45.1% (CI, 18.6% to 63.1%; P�<�0.001). Conclusions: In normotensive patients with type 1 diabetes mellitus and microalbuminuria, ACE inhibitors significantly reduced progression to macroalbuminuria and increased chances of regression. Beneficial effects were weaker at the lowest levels of microalbuminuria but did not differ according to other baseline risk factors. Changes in blood pressure cannot entirely explain Continue reading >>
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Accepted Manuscript - Manuscripts that have been selected for publication. They have not been typeset and the text may change before final publication. Uncorrected Proof - Articles that are not yet finalized and that will be corrected by the author(s). The text could change before final publication. (Uncorrected proofs may be temporarily unavailable for production reasons) Corrected Proof - Articles containing author corrections will usually remain unchanged and possible further corrections are fairly minor. Typically the only difference with the final published article is that specific issue and page numbers have not yet been assigned. Although these articles do not have all bibliographic details available yet, they can be cited using the year of online publication and the DOI as follows: Author(s), Article title, Publication (year), DOI. Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names, and use of punctuation. Continue reading >>
Ace Inhibitors
A class of medicine usually used to treat high blood pressure. Angiotensin-converting enzyme (ACE) inhibitors also appear to protect people with diabetes from diabetic nephropathy (kidney disease). People with diabetes are especially prone to hypertension (defined as a blood pressure level of 140/90 mm Hg or greater). Some 20% to 60% of individuals with diabetes have high blood pressure. Hypertension increases their risk not only of heart disease and stroke, but also of peripheral vascular disease, diabetic retinopathy, diabetic nephropathy, and possibly diabetic neuropathy. The American Diabetes Association (ADA) currently recommends a target blood pressure level of under 130/80 mm Hg in people with diabetes. The ADA recommends a number of different measures for lowering blood pressure, including weight loss, sodium restriction, and exercise. When these measures aren’t enough, the addition of one or more medicines is warranted. There are several different classes of blood pressure drugs, including angiotensin-receptor blockers (ARBs), diuretics, beta blockers, and ACE inhibitors. Overall, drug therapy has been shown to substantially decrease the risk of cardiovascular disease, diabetic retinopathy, and diabetic nephropathy. ACE inhibitors may have a special advantage in terms of slowing the progression of diabetic nephropathy. Research findings show that ACE inhibitors can slow the progression of kidney disease to a greater degree than other antihypertensive drugs that lower blood pressure by a similar amount and that they may be able to protect the kidneys even in people with diabetes whose blood pressure levels are in the normal range. This suggests that ACE inhibitors protect the kidneys by mechanisms other than just blood pressure control. Currently, the ADA reco Continue reading >>
Angiotensin-converting Enzyme (ace) Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors treat a variety of conditions, such as high blood pressure, scleroderma and migraines. Find out more about this class of medication. Angiotensin-converting enzyme (ACE) inhibitors help relax blood vessels. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that narrows your blood vessels and releases hormones that can raise your blood pressure. This narrowing can cause high blood pressure and force your heart to work harder. Many ACE inhibitors are available. Which one is best for you depends on your health and the condition being treated. People with chronic kidney disease may benefit from having an ACE inhibitor as one of their medications. People of African heritage and older people respond less well to ACE inhibitors than do white and younger people. In rare cases but more commonly in people of African heritage and in smokers ACE inhibitors can cause some areas of your tissues to swell (angioedema). If it occurs in the throat, the swelling can be life-threatening. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), decrease the effectiveness of ACE inhibitors. Taking an occasional dose of these medications shouldn't change the effectiveness of your ACE inhibitor, but talk to your doctor if you regularly take NSAIDs. Because ACE inhibitors can cause birth defects, talk to your doctor about other options to treat your blood pressure if you're pregnant or you plan to become pregnant. Continue reading >>
Ace Inhibitors: Blood Pressure Control In Diabetes
ACE Inhibitors: Blood Pressure Control in Diabetes Angiotensin converting enzyme (ACE) inhibitors are oral medications that lower blood pressure. ACE inhibitors are used to treat hypertension (high blood pressure), coronary artery disease and heart failure, and to help to control the progression of diabetes and kidney disease. These disease processes tend to go hand in hand; high blood pressure is very common among people with diabetes. High blood pressure also contributes to the development of diabetic nephropathy (kidney disease). Furthermore, those with diabetes tend to have worse outcomes (longer hospitalizations, longer recovery times and higher risks of infection) from major heart problems. Therefore, health-care providers treat hypertension in concert with diabetes . While ACE inhibitors don't directly lower blood sugar, they can contribute to blood sugar control by increasing the bodys sensitivity to insulin. Insulin helps the body metabolize glucose (sugar) and move it from the bloodstream into cells, where it acts as a source of energy. Many ACE inhibitors are available in the United States, including Capoten (captopril), Prinivil and Zestril (lisinopril), Vasotec (enalapril), Lotensin (benazepril), Altace (ramipril), Accupril (quinapril), Monopril (fosinopril), Mavik (trandolapril), Aceon (perindopril) and Univasc (moexipril). ACE inhibitors lower blood pressure by preventing the body from producing the hormone angiotensin II. Angiotensin II causes vasoconstriction (narrowing of blood vessels) and fluid retention, resulting in hypertension. By reducing blood pressure and fluid retention, ACE inhibitors help to control heart failure. ACE inhibitors may also prevent and control diabetic nephropathy (kidney disease) and help control diabetic retinopathy (eye pr Continue reading >>
Renoprotective Effect Of Angiotensin-converting Enzyme Inhibitors And Angiotensin Ii Receptor Blockers In Diabetic Patients With Proteinuria
Abstract Background/Aims: Limited evidence exists on the choice of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in diabetic patients with nephropathy. We aim to assess the renal effectiveness and safety of these drugs among diabetic nephropathy patients. Methods: This retrospective cohort study was conducted with diabetic nephropathy patients who initiated ACEI or ARB monotherapy. The primary outcome was a composite of end stage of renal disease and renal transplantation, and the secondary outcome was all-cause mortality. The safety endpoint was hyperkalemia. Results: Three thousand seven hundred and thirty-nine ACEI users and 3,316 ARB users were identified. ARBs seemed to be inferior to ACEIs given their poorer renal outcome (HR 1.31; 95% CI, 1.15-1.50) and higher risk of hyperkalemia (HR 1.17; 95% CI, 1.04-1.32). Among the four ACEIs compared, captopril was an inferior treatment choice given its poorer renal outcomes (HR 1.42; 95% CI, 1.05-1.93) and higher mortality rate (HR 1.25; 95% CI, 1.01-1.55). Irbesartan appeared to be a poorer treatment choice among the three ARBs compared, given its inferior renal protective effect (HR 1.35; 95% CI, 1.03-1.78). Conclusions: Our findings suggest ACEIs as a relatively more renoprotective and safer treatment as compared to ARBs. Captopril and irbesartan may be inferior to the other ACEIs and ARBs respectively. © 2017 The Author(s). Published by S. Karger AG, Basel Introduction Diabetic nephropathy is a common complication among patients with diabetes mellitus (DM) and the leading cause of chronic kidney disease (CKD) in developed countries [1]. It involves an increase in proteinuria and decrease in glomerular filtration rate. The continuous kidney damage can lead to irreversible Continue reading >>
