From the Guidelines
Angiotensin-Converting Enzyme Inhibitors (ACE-I) play a crucial role in managing hypertension, particularly in patients with or at high risk for cardiovascular disease.
Key Benefits of ACE-I
- Reducing initial ischemic heart disease events and recommended for consideration in all patients after myocardial infarction 1
- Proven to forestall and treat heart failure and kidney failure 1
- Reducing the incidence of recurrent stroke when combined with thiazide-type diuretics 1
Clinical Trials Supporting ACE-I Use
- The HOPE trial demonstrated a 22% reduction in the composite end point of cardiovascular death, myocardial infarction, and stroke with ramipril therapy 1
- The EUROPA trial showed a 20% relative risk reduction in the primary end point, a composite of cardiovascular death, myocardial infarction, or cardiac arrest with perindopril therapy 1
Guideline Recommendations
- The JNC 7 report states that thiazide-type diuretics should be used as initial therapy for most patients with hypertension, alone or in combination with another agent, such as an ACE inhibitor or a beta blocker 1
From the FDA Drug Label
Lisinopril inhibits angiotensin-converting enzyme (ACE) in human subjects and animals. 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. Lisinopril tablets USP are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure.
The role of Angiotensin-Converting Enzyme Inhibitors (ACE-I), such as lisinopril, in managing hypertension is to:
- Suppress the renin-angiotensin-aldosterone system
- Decrease plasma angiotensin II, leading to decreased vasopressor activity and aldosterone secretion
- Lower blood pressure in patients with hypertension, reducing the risk of fatal and non-fatal cardiovascular events 2 2 Key benefits of ACE-I in hypertension management include:
- Reduction of cardiovascular morbidity and mortality
- Decrease in the risk of stroke and myocardial infarction
- Ability to be used alone or in combination with other antihypertensive agents
From the Research
Mechanism of Action
- Angiotensin-Converting Enzyme Inhibitors (ACE-I) work by reducing preload and afterload on the heart, preventing ventricular remodeling, and retarding atherogenic changes in the vessel walls 3
- ACE-I inhibit the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby lowering blood pressure 4
Clinical Applications
- ACE-I are indicated for the treatment of hypertension, coronary artery disease, heart failure, and chronic kidney disease 4
- They are also used to slow the progression of kidney disease, especially in diabetic patients 3
- ACE-I have been shown to reduce the risk of cardiovascular morbidity and mortality, particularly in high-risk individuals 3, 5
Benefits and Advantages
- ACE-I can reduce the risk of cardiovascular events, such as myocardial infarction and stroke, by lowering blood pressure and reducing the workload on the heart 6, 5
- They can also reduce left ventricular mass and improve cardiac function in patients with heart failure 7
- ACE-I have been shown to be effective in reducing proteinuria and slowing the progression of kidney disease in patients with chronic kidney disease 7, 4
Side Effects and Contraindications
- ACE-I can cause side effects such as cough, angioedema, and hyperkalemia, especially in patients with renal impairment or those taking other medications that affect potassium levels 4
- They are contraindicated in pregnancy due to fetal toxicity and should be used with caution in patients with autoimmune diseases or those undergoing treatment with immunosuppressive drugs 7, 4