Effects of angiotensin-converting enzyme inhibitors on the heart and vessels in clinical and experimental hypertension - A review

The primary aim of antihypertensive therapy is to reduce blood pressure. Whatever their mechanisms of action, almost all the antihypertensive drugs currently available can be considered to achieve this goal. However, the most common complications of hypertension (myocardial infarction, thrombolytic stroke and sudden cardiac death) are related to structural cardiovascular changes rather than bring directly related to blood pressure elevation. Thus, it would appear logical that an optimum antihypertensive:sive drug should also prevent and reverse the cardiovascular abnormalities associated with hypertension before irreversible damage occurs. The different classes of antihypertensive drug are in fact largely successful in preventing or reversing these target abnormalities, in particular cardiac and vascular abnormalities. In hypertensive patients, angiotensin-converting enzyme (ACE) inhibitors appear to be particularly effective in achieving this goal. probably because they alter vascular wall and cardiac structure, irrespective to some extent of the haemodynamic changes they produce. ACE inhibitors may have particularly beneficial effects on left ventricular mass because of their favourable interference with growth factors, an increased production of bradykinin, and hence of nitric oxide, may add further benefit. ACE inhibitors also prevent and/or reduce reactive perivascular and interstitial growth, as well as fetalisation of cardiac myocytes. Furthermore, in common with calcium channel antagonists and nitrates, ACE inhibitors improve arterial compliance. and thus decrease cardiac load. Indirect evidence suggests that a reduction in left ventricular hypertrophy during antihypertensive therapy reverses the pathological consequences of an increased left ventricular mass. although further studies are needed to assess the true clinical impact of these treatment-induced changes in the morbidity and mortality of hypertensive patients.