Pathophysiology of congestive heart failure: role of angiotensin-converting enzyme inhibitors

Article Abstract:

The enzyme renin is produced by the kidneys. Renin converts the blood protein angiotensinogen to angiotensin I, which is then converted to angiotensin II by angiotensin-converting enzyme (ACE). Angiotensin II is a potent vasopressor, in that it constricts blood vessels, and also increases the production and release of the mineralocorticoid hormone aldosterone from the adrenal gland. Aldosterone controls the metabolism of sodium, chloride, and potassium. Agents which prevent the action of ACE and the formation of angiotensin II have been used to treat hypertension, or abnormally high blood pressure. ACE inhibitors have also been beneficial in treating congestive heart failure, or the inability of the heart to maintain circulation, which results in fluid accumulation in the lungs. ACE inhibitors may reverse myocardial hypertrophy, or enlargement of the heart, decrease the pressure that causes the left ventricle to fill with blood, and decrease the size of the left ventricle. Administered over the long term, ACE inhibitors may have beneficial effects on circulation throughout the rest of the body. The power of ACE inhibitors to improve the ability of blood vessels to dilate in response to exercise, to increase blood flow to the kidney and the excretion of sodium in the urine, and to prevent hypokalemia, or decreased blood potassium levels, should contribute to the exercise capacity, quality of life, and survival of patients with severe congestive heart failure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Congestive heart failure, Congestive heart failure agents

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Choice of drug treatment for elderly hypertensive patients

Article Abstract:

Most physicians agree that moderate and severe hypertension in the elderly should be treated. It is less clear which antihypertensive drugs are most effective, while producing the fewest and least severe side effects. The underlying cause of hypertension must be considered, as must the drug's effects on any other illnesses the patient may have. The stepped-care approach, beginning with a diuretic, then adding second drug, then a third, until the target blood pressure is reached, is too rigid. A better approach is to individualize treatment. The advantages and disadvantages, including side effects, of thiazide diuretics, beta blockers, vasodilators, alpha blockers, calcium antagonists, serotonin antagonists, and angiotensin-converting enzyme (ACE) inhibitors are discussed. Although they are used extensively in the United States, the diuretics and the beta blockers have many unpleasant side effects. Twenty years of evidence indicate that beta blockers have a negative effect on thought processes. They also cause depression, sleep disturbances, and decreased alertness. For the elderly, ACE inhibitors and calcium channel blockers work well with fewer side effects. Alpha blockers and ketanserin are still questionable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aged, Elderly, Complications and side effects, Physiological aspects, Antihypertensive drugs, Antihypertensive agents

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Efficacy and safety of cilazapril in hypertensive patients with moderate to severe renal impairment

Article Abstract:

The safety and effectiveness of the new angiotensin-converting enzyme inhibitor cilazapril was evaluated in 25 patients with hypertension, or abnormally high blood pressure, and impaired kidney function. In these patients, the diastolic blood pressure, or blood pressure during the relaxation phase of the heart cycle, ranged from 95 millimeters of mercury (mm Hg) to 115 mm Hg. The doses of cilazapril therapy were between 0.5 to 5.0 milligrams (mg) per day. Blood pressure decreased after eight weeks of therapy. There was no orthostatic effect, or decrease in blood pressure upon standing, and no deterioration of kidney function. Cilazapril did not cause serious adverse effects with the exception of some cases of increased blood potassium especially in patients with acidosis, or decrease in the blood pH. The results indicate that cilazapril is relatively safe and effective for treating hypertension in patients with impaired kidney function. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Kidney diseases, Cilazapril

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