Angiotensin-converting enzyme inhibitors in the treatment of heart failure

The article is professionally consulted by Master, Doctor La Thi Thuy - Cardiovascular Center - Vinmec Central Park International General Hospital

Angiotensin-converting enzyme inhibitors are considered the first choice in the treatment of cardiovascular diseases such as hypertension and heart failure. Most of the names of drugs in this class end with the ending "pril", such as captopril, enalapril,...

Angiotensin-converting enzyme inhibitors are also known as ACE inhibitors, abbreviated as ACEI, or ACE inhibitors, where ACE is the name for the phrase "angiotensin-converting enzyme", meaning angiotensin-converting enzyme. Angiotensin is essentially a protein that causes blood vessel constriction and increases blood pressure. ACE inhibitors help reduce blood pressure by dilating blood vessels, reducing peripheral resistance, thereby reducing pressure on the vessel walls.
ACE inhibitors are the preferred drug group indicated for patients with hypertension, in addition, this group of drugs is also used in other cases, including:
Heart failure: Helps reduce the burden on the heart. Lowering blood pressure will make it easier for the heart to pump blood to the body when the heart is failing. Therefore, the drug can slow down the progression of heart failure and prolong the patient's life; Myocardial Infarction: Helps prevent the risk of myocardial damage due to ischemia and increases the patient's ability to recover from myocardial infarction; Diabetic kidney disease: Angiotensin-converting enzyme inhibitors slow down the progression of kidney failure in patients with type 2 diabetes, limiting dangerous complications; Cardiovascular disease prevention: For people at high risk of cardiovascular disease, ACEIs help reduce the risk of heart attack and stroke. The most commonly used angiotensin converting enzyme inhibitors today are captopril, enalapril, lisinopril, ramipril, moexipril, perindopril,...

Renin is a substance secreted by the paraglomerular cells (Macula densa cells) when the blood flow to the kidney decreases, the filtration rate required by the kidneys decreases (in the picture above, it is due to decreased circulating volume, low blood pressure). It catalyzes a reaction that converts angiotensinogen produced in the liver to angiotensin I. Then, thanks to the enzyme ACE in the lungs, angiotensin I is converted to angiotensin II. Angiotensin II binds to the AT1, AT2, AT3 and AT4 receptors and induces a response. The following three receptors have not been studied much. The AT1 receptor plays the most important role in the effect on blood pressure and is the main target of angiotensin II. When angiotensin II binds to the receptor, a response occurs: sympathetic hyperactivity, vasoconstriction, activation of the aldosterone-secreting adrenal cortex, increased sodium and water retention, and an increase in circulating volume... have an effect on blood pressure.

All ACE inhibitors inhibit ACE activity by competitive inhibition. When ACE is inhibited, angiotensin II is not produced, the drug produces the following responses:
Vasodilation: Because ACE is inhibited, angiotensin II decreases and ADH (anti-diabetic hormone) in the blood plasma decreases, reducing strength. peripheral circulatory obstruction. Selective vasodilation of important tissues (brain, kidney, coronary...), redistribution of blood, reduction of preload and afterload. Improve blood vessel function: Increase elasticity and reduce vascular wall hypertrophy. Direct or indirect parasympathetic stimulation via prostaglandins, causes loss of the sympathetic reflex of angiotensin II on the barotropic reflex. Reduces hypertrophy, ventricular fibrosis, interventricular septum. Increased sodium excretion, potassium retention by reducing the effect of aldosterone. Increased uric acid excretion. Increased glomerular filtration rate due to increased blood flow to the kidney. Increased glucose absorption, insulin sensitivity. The above effects help lower blood pressure, protect cardiovascular function...
In addition, ACE enzyme also degrades bradykinin. When ACE is inhibited, bradikinin is not broken down and accumulates leading to a common side effect of this class of drugs, which is coughing. This cough does not respond to central cough suppressants and the only way to overcome this side effect is to change the medication

Angiotensin-converting enzyme inhibitors are usually taken 1 hour before meals. Depending on each drug and the patient's medical condition, the doctor will prescribe a different dose and number of times a day. During the use of this drug, patients should have their blood pressure checked and liver and kidney function assessed regularly.
In all cases, the patient should follow the doctor's treatment instructions. Do not suddenly stop taking the medicine without the consent of the doctor, even if the patient feels that the medicine is not working for his condition. Especially in the treatment of heart failure, the symptoms caused by the disease such as cough, edema, prolonged fatigue... may not be improved immediately after taking the drug, but the long-term benefits have been studied. Studies have shown that the drug can prevent heart failure from getting worse.

4.1. With other drugs The use of ACE inhibitors with other drugs may affect the effectiveness of treatment:
Non-steroidal anti-inflammatory drugs (including aspirin, ibuprofen, naproxen...): There is a risk of causing cause salt and water retention in the body, thereby reducing the antihypertensive effect of ACE inhibitors; Diuretics and other antihypertensive drugs: Causes synergistic effects, leading to excessively low blood pressure; Potassium-sparing diuretics (including amiloride, spironolactone, triamterene...): Risk of excessive hyperkalemia. Therefore, before treatment with angiotensin-converting enzyme inhibitors, patients need to inform about the drugs they are taking so that the doctor can prescribe a dose reduction or change other drugs to minimize the risk of interactions.
4.2. With food Taking ACE inhibitors along with foods rich in potassium such as bananas, orange juice, cruciferous vegetables such as spinach, cauliflower, cabbage... can lead to excessive hyperkalemia. Therefore, patients need to pay attention to limit the inclusion of these foods in their daily diet and avoid salt containing potassium.

Patients with heart failure can choose to be treated at Vinmec International General Hospital. Here gathers a team of specialists in Cardiology including professors, doctors, masters, specialist doctors 2 experienced, have great reputation in the field of medical treatment, surgery, information interventional heart. Vinmec also focuses on applying advanced techniques in the diagnosis and treatment of cardiovascular diseases, using a system of modern medical equipment that meets international standards.
Master. Dr. La Thi Thuy is currently an interventional cardiologist at Vinmec Central Park International General Hospital. Graduated as a general practitioner from the University of Medicine and Pharmacy in Ho Chi Minh City. Ho Chi Minh City in 2010, and graduated with a master's degree in cardiology from the University of Sheffield (UK). Doctor Thuy Trained in practicing cardiology at Royal Hallamshire hospital. The doctor has worked at the Department of Interventional Cardiology, Cho Ray Hospital from 2012-2016.