Should an angiotensin-converting enzyme inhibitor be standard therapy for patients with atherosclerotic disease?

O'Keefe, James H., Wetzel, Mark, Moe, Richard R., Brosnahan, Kathleen and Lavie, Carl J. (2001) Should an angiotensin-converting enzyme inhibitor be standard therapy for patients with atherosclerotic disease?. Journal of the American College of Cardiology, 37 1: 1-8. doi:10.1016/S0735-1097(00)01044-5


Author O'Keefe, James H.
Wetzel, Mark
Moe, Richard R.
Brosnahan, Kathleen
Lavie, Carl J.
Title Should an angiotensin-converting enzyme inhibitor be standard therapy for patients with atherosclerotic disease?
Journal name Journal of the American College of Cardiology   Check publisher's open access policy
ISSN 0735-1097
1558-3597
Publication date 2001-01-01
Year available 2001
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/S0735-1097(00)01044-5
Open Access Status DOI
Volume 37
Issue 1
Start page 1
End page 8
Total pages 8
Place of publication San Diego, CA, United States
Publisher Elsevier
Language eng
Abstract Angiotensin-converting enzyme (ACE) inhibitors appear to possess unique cardioprotective benefits, even when used in patients without high blood pressure or left ventricular dysfunction (the traditional indications for ACE inhibitor therapy). The ACE inhibitors improve endothelial function and regress both left ventricular hypertrophy and arterial mass better than other antihypertensive agents that lower blood pressure equally as well. These agents promote collateral vessel development and improve prognosis in patients who have had a coronary revascularization procedure (i.e., percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery). Insulin resistance, present not only in type 2 diabetes but also commonly in patients with hypertension or coronary artery disease, or both, sensitizes the vasculature to the trophic effects of angiotensin II and aldosterone. This may partly explain the improvement in prognosis noted when patients who have atherosclerosis or diabetes are treated with an ACE inhibitor. Therapy with ACE inhibitors has also been shown, in two large, randomized trials, to reduce the incidence of new-onset type 2 diabetes through largely unknown mechanisms. The ACE inhibitors are safe, well tolerated and affordable medications. The data suggest that most people with atherosclerosis should be considered candidates for ACE inhibitor therapy, unless they are intolerant to the medication, or have systolic blood pressures consistently <100 mm Hg. Patients who show evidence of insulin resistance (with or without overt type 2 diabetes) should also be considered as candidates for prophylactic ACE inhibitor therapy. Although angiotensin receptor blockers should not be considered equivalent to ACE inhibitors for this indication, they may be a reasonable alternative for patients intolerant of ACE inhibitors.
Keyword Angiotensin-converting enzyme inhibitor
Left ventricular dysfunction
Endothelial function
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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Created: Mon, 14 Mar 2011, 19:37:33 EST