Does high Angiotensin-Converting Enzyme (ACE) activity indicate Hypertension?

From the Guidelines

High angiotensin-converting enzyme (ACE) activity does not directly indicate hypertension, as ACE levels do not correlate with blood pressure readings. ACE is an enzyme involved in regulating blood pressure, converting angiotensin I to angiotensin II, which can constrict blood vessels and increase blood pressure 1. However, many other factors also influence blood pressure, and some people may have elevated ACE levels without hypertension, while others may have normal ACE levels but still have high blood pressure.

Key Points to Consider

• ACE levels do not directly correlate with blood pressure readings 1
• Blood pressure is best measured directly using a blood pressure cuff rather than inferred from ACE levels
• Hypertension is diagnosed based on consistent readings above 130/80 mmHg 1
• ACE inhibitors are a recommended treatment for hypertension, especially in patients with cardiovascular disease 1, 1

Recommendations for Hypertension Diagnosis and Treatment

• If concerned about hypertension, have blood pressure checked regularly by a healthcare provider 1
• Healthcare providers can diagnose hypertension based on consistent readings above 130/80 mmHg and recommend appropriate lifestyle changes or medications if needed 1
• ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and diuretics are recommended treatments for hypertension 1

From the FDA Drug Label

ACE is a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. The beneficial effects of lisinopril in hypertension and heart failure appear to result primarily from suppression of the renin-angiotensin-aldosterone system. Inhibition of ACE results in decreased plasma angiotensin II which leads to decreased vasopressor activity and to decreased aldosterone secretion.

High ACE activity is associated with the conversion of angiotensin I to angiotensin II, a vasoconstrictor substance.

• The renin-angiotensin-aldosterone system plays a key role in hypertension.
• Inhibition of ACE leads to decreased plasma angiotensin II, resulting in decreased vasopressor activity. However, the FDA drug label does not directly state that high ACE activity indicates hypertension. The label only describes the role of ACE in the renin-angiotensin-aldosterone system and its relation to blood pressure regulation 2.

From the Research

Relationship Between ACE Activity and Hypertension

• High Angiotensin-Converting Enzyme (ACE) activity is associated with an increased risk of hypertensive cardiovascular events 3.
• The renin-angiotensin system (RAS), which includes ACE, plays a crucial role in blood pressure control and is a potential therapeutic target for the treatment of hypertension 4.
• ACE inhibitors, which reduce ACE activity, are commonly used to treat hypertension and have been shown to lower blood pressure in patients with primary hypertension 5.

Mechanisms of ACE in Hypertension

• ACE converts Angiotensin I (Ang I) to Angiotensin II (Ang II), a potent vasoconstrictor that increases blood pressure 4, 6.
• ACE also degrades bradykinin, a vasodilator, which can further contribute to increased blood pressure 4.
• High ACE levels have been linked to an increased risk of ischemic stroke and coronary heart disease, particularly in patients with high blood pressure 3.

Clinical Implications

• ACE inhibitors are effective in lowering blood pressure and reducing the risk of cardiovascular events in patients with hypertension 7, 5.
• The use of ACE inhibitors has been associated with a reduced risk of stroke and coronary heart disease in patients with high vascular risk 3.
• However, ACE inhibitors can also have potential side effects, such as cough, skin rashes, and hyperkalemia, particularly in patients with severe renal impairment 7.