Aspirin, Beta blockers, and Ace Inhibitors (cont.)
What are ACE inhibitors?
Angiotensin II is a naturally-produced chemical that helps the body to
normally maintain blood pressure. Angiotensin II powerfully constricts the blood
vessels and stimulates water and salt retention, which in turn causes a rise in
blood pressure. ACE (angiotensin converting enzyme) inhibitors are drugs that
block, or inhibit, the formation of angiotensin II and are thus effective in
lowering blood pressure.
The goal of treating high blood pressure (HBP or
hypertension) traditionally has been to reduce the blood pressure to a certain
level (e.g., to less than 140/90). More recently, however, it has become
apparent that how you lower the blood pressure (that is, what drugs you use) is
also important. It seems that the ARB (angiotensin receptor blockers) and ACE
inhibitor drugs produce added protective effects on the heart, kidneys, and
brain. In other words, the protective effects of these classes of drugs on these
organs in patients with HBP far exceed the protective effects produced by
lowering the blood pressure alone.
Just what added protection do the ARB and ACE inhibitors provide? In the heart, these drugs reduce heart attacks (myocardial infarction), and
in the brain, they reduce strokes. In the kidneys, ARB and ACE inhibitors have
been shown to reduce proteinuria (loss of protein in the urine), preserve renal
(kidney) function, and slow the progression of renal failure, especially in
diabetics.
Recently, an ACE inhibitor, ramipril (Altace), received FDA approval
for another usage (indication) in addition to treating HBP. This drug is now
approved for selected individuals (even without HBP) to reduce their risks of
strokes and heart attacks. These selected individuals are either over age 55
with a history of cardiovascular disease or have diabetes and at least one other
risk factor for cardiovascular disease, such as smoking or elevated blood
cholesterol. Previously, ACE inhibitors also were studied in patients without
HBP who had weakened heart muscle (heart failure) following a heart attack. In
these studies, the ACE inhibitors were shown to reduce subsequent heart problems
(cardiac events) for these patients.
Furthermore and finally, data are rapidly appearing to support the suggestion
that ARB and ACE inhibitor drugs produce several effects that fight cholesterol
buildup. This new information, coupled with the above-mentioned protective
effects on the brain, heart, and kidneys, is quite exciting. Thus, these two
classes of anti-hypertensive drugs appear to provide patients with additional
benefits (bonuses, if you will) beyond those provided by just lowering the blood
pressure. Whether any one drug in a class is better than any other drug in that
class, however, remains to be proven. Accordingly, the choice of a specific drug
within each class of drugs is currently most often determined by the drug's
price, insurance restrictions, and the doctor's preference.
Beta blockers: In patients who have sustained a myocardial infarction, the long-term
administration of a class of drugs known as beta-blockers has been demonstrated
to result in a much lower incidence of recurrent heart attacks, and may improve
survival by as much as 40%. For this reason, the use of these agents is
considered in most patients.
Last Editorial Review: 7/26/2006
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