From the Guidelines
ACE inhibitors increase renin levels.
Mechanism of Action
- ACE inhibitors block the conversion of angiotensin I to angiotensin II, which is a potent vasoconstrictor 1.
- As a result, the levels of angiotensin II decrease, leading to a decrease in negative feedback on renin release 1.
- This decrease in negative feedback causes an increase in renin levels, as the body attempts to compensate for the decreased angiotensin II levels 1.
Clinical Implications
- Despite the initial increase in renin levels, ACE inhibitors have been shown to have multiple mechanisms of benefit for patients with heart failure, coronary disease, and other atherosclerotic vascular disease, as well as diabetic nephropathy 1.
- The renin-angiotensin system demonstrates partial "escape" from inhibition with chronic therapy with ACE inhibitors, allowing for potential benefit from additional therapy with ARBs and aldosterone antagonists 1.
From the Research
Effect of ACE Inhibitors on Renin
- ACE inhibitors increase plasma renin levels as a reactive response to the decrease in angiotensin II levels 2
- The combination of ACE inhibitors and angiotensin II antagonists has an additive effect on plasma renin rise 2
- Treatment with ACE inhibitors, such as ramipril, increases human tissue renin levels, particularly in vascular tissues 3
- ACE inhibitors can reduce preload and afterload on the heart, prevent ventricular remodeling, and even retard atherogenic changes in the vessel walls, which may be related to their effect on renin 4
- The renin-angiotensin-aldosterone system plays a crucial role in regulating blood pressure and body volume, and ACE inhibitors act on this system to produce their effects 4, 5
Mechanism of Action
- ACE inhibitors reduce the conversion of angiotensin I to angiotensin II, leading to a decrease in blood pressure and an increase in renin release 2, 4
- The decrease in angiotensin II levels leads to a reactive increase in renin release, which can be further enhanced by the combination of ACE inhibitors and angiotensin II antagonists 2
- ACE inhibitors can also reduce the intrarenal effects of angiotensin II, such as increased glomerular capillary pressure and mesangial cell contraction, which may contribute to their renal protective effects 6
Clinical Implications
- ACE inhibitors are widely used as antihypertensives and have been shown to reduce the risk of cardiovascular morbidity and mortality 4
- The use of ACE inhibitors in patients with chronic kidney disease requires careful consideration of their potential adverse effects, such as hypotension, renal function impairment, and hyperkalemia 5
- The combination of ACE inhibitors with other agents, such as diuretics, may enhance their therapeutic effects and minimize their adverse effects 5