Angiotensin Converting Enzyme Inhibitors and AT1 Antagonists for Treatment of Hypertension

Part of the Current Cardiovascular Therapy book series (CCT, volume 5)


Essential hypertension is the major cardiovascular risk factor. The main objective of treatment of essential hypertension is represented by long-term reduction of cardiovascular (CV) risk. This goal can be achieved through the control of blood pressure (BP) values, the prevention of hypertension-related target organ damage (TOD) and metabolic complication, and reduction of CV events. During the last 25 years has emerged that the dysregulation of rennin-angiotensin-system (RAS) plays a pivotal role not only in the genesis of hypertension, but also in the development of TOD, diabetes, obesity, atherosclerosis and their complications. In fact, it has been documented that angiotensin II (Ang II), the effector of RAS, is involved in the regulation of endothelial function, tissue remodeling, inflammation, oxidative stress, differentiation of adipocytes, glucose metabolism and electrolytes homeostasis. Therefore, it does not surprise if the principal interventional trials have demonstrated that the blocking of the RAS, obtained either with angiotensin converting enzyme (ACE)-inhibitors, or with the type 1 Ang II (AT1) receptors blockers (ARBs), reduce the incidence of CV events in hypertensive and high CV risk patients. ACE-inhibitors block the conversion of angiotensin-I into Ang II reducing the circulating and local levels of Ang II. ACE-inhibitors also reduce the release of aldosterone and vasopressin, decrease the activity of sympathetic nervous system, as well as the trophic effects of Ang II on cardiac muscle and vessels. The inhibition of ACE produces also an increase in plasma bradykinin levels, which in turn, stimulates the type 2 bradykinin (B2) receptors leading to the release of nitric oxide (NO), and vasoactive prostaglandins (prostacyclin and prostaglandin E2). These biological effects are translated in several pharmacological actions consisting in the reduction of BP, in the decrease of plasma levels of epinephrine, norepinephrine and vasopressin, in the interference with development of vascular and cardiac hypertrophy and extracellular matrix proliferation, in the decrease renal vascular resistances and increase renal blood flow, which in turn, promotes Na+ and water excretion, in the modulation of fibrinolytic balance resulting in antithrombotic effect.


ACE ACEi Hypertension AT1 AT1 Antagonists RAS Ang II Cardiovascular ARBs 


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© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Dipartimento di Scienze Mediche Traslazionali e Dipartimento di Scienze Biomediche AvanzateUniversità FEDERICO II NapoliNaplesItaly

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