1/9/2024 0 Comments Ace and hearts![]() Current recommendations are using ACEi or ARB as first-line therapy for hypertension in patients with a history of diabetes. ![]() A large, prospective, randomized, placebo-controlled has demonstrated that ACE inhibitors slow down the progression of nephropathy in patients with insulin-dependent diabetes mellitus and significantly reduce the combined endpoints of dialysis, transplantation, and death. The Renin-Angiotensin-Aldosterone system and increased glomerular capillary pressure have been reported to increase the progression of renal dysfunction due to diabetes mellitus related nephropathy. ![]() It is also recommended that all patients should be treated with ACE inhibitors initially, with a review of the need for continuation later based on left ventricular function assessment. ![]() The clinical practice guidelines in the contemporary era recommend that patients with left ventricular dysfunction or heart failure be treated with ACE inhibitors without delay after infarction. The vast majority of these trials have shown a significant decrease in mortality and a slowing of the progression to congestive heart failure after MI in patients treated with ACE inhibitors. Over the last few decades, several prospective, randomized trials have studied the effect of ACE inhibitors on mortality after myocardial infarction (MI). Based on the above-mentioned evidence, ACE inhibitors are strongly recommended as first-choice therapy in patients with heart failure. These trials demonstrated that ACE inhibitors reduce mortality even in asymptomatic patients with left ventricular dysfunction. Since the 1980s, several large, prospective, randomized, placebo-controlled trials have proved that treatment with ACE inhibitors reduces overall mortality, especially in patients with heart failure with reduced ejection fraction (0HFrEF). Apart from decreasing the afterload, ACEIs also reduce cardiac myocyte hypertrophy. ACE inhibitors play an important role in promoting salt excretion by augmenting the renal blood flow and reducing aldosterone and antidiuretic hormone production. Īngiotensin-converting enzyme inhibitors (ACEIs) improve heart failure by decreasing afterload, preload, and systolic wall stress, which results in increased cardiac output without any increase in heart rate. Although ACE inhibitors are generally very effective antihypertensive drugs, they have been proven to be less effective in hypertensive Black race individuals than in whites in clinical practice. Recent guidelines released by the American Heart Association/American College of Cardiology (AHA/ACC) and the European Society of Cardiology (ESC) also recommend ACE inhibitors as first-line antihypertensive therapy, especially in patients with diabetes mellitus and cardiovascular diseases. Only thiazide and calcium channel blockers are recommended as initial therapy for the general black population with elevated blood pressure. The other three classes of drugs are calcium channel blockers, thiazide diuretics, and angiotensin receptor blockers, which are useful as initial therapy for the general nonblack population. ![]() In 2014, the Eighth Joint National Commission (JNC8) published evidence-based guidelines for treating high blood pressure in adults, which recommended that ACE inhibitors are one of four drug classes recommended for initial therapy for adults with elevated blood pressure. Angiotensin-converting enzyme inhibitors have been evaluated as antihypertensive drugs in multiple randomized controlled trials. Īngiotensin-converting enzyme inhibitors effectively lower the mean arterial blood pressure as well as systolic and diastolic blood pressure both in hypertensive and normotensive subjects. Angiotensin-converting enzyme inhibitors (ACEIs) are the most commonly indicated medications in the treatment of cardiovascular and renal diseases, including heart failure, acute coronary syndrome, nephrotic syndrome, diabetes, and hypertension. ![]()
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