A REVIEW ON THE EFFECTIVENESS OF ANGIOTENSIN CONVERTING ENZYME INHIBITORS IN REDUCING CARDIOVASCULAR MORBIDITY AND MORTALITY RISKS

Abstract

Angiotensin converting enzyme inhibitors (ACEIs) are long been preferred as a therapeutic choice for cardiovascular disease due to its safe supremacy to overcome the deleterious effects of Angiotensin II, which is a strong vasoconstrictor increases the levels of different growth factors and adhesion molecules. It produces an oxidative stress that accounts for its apoptotic properties. The cardiac myocyte undergoes necrosis induced by angiotensin II and it also activates neurohumoral system in post infarction left ventricular dysfunction patients.  ACE inhibitors reduce the production of angiotensin II by endothelial cells. It also simultaneously diminishes the deprivation of bradykinin that results in vasodilation to overcome the effects of angiotensin II by exerting its anti-apoptotic actions. Clinical trials such as SAVE, SOLVD, AIRE and TRACE indicated that the life expectancy can be increase by ACE inhibitors in patients having left ventricular dysfunction.  EUROPA study suggested that in all patients of coronary heart diseases, perindopril is a treatment of choice along with other preventive therapies. Evidences of clinical researches supports the usage of ACE inhibitors and showed improve clinical results in patients with primary hypertension, stable coronary artery diseases, stable ischemic diseases with preserved ventricular function or reduced ventricular function, and myocardial infarction.FDA has approved that ACE inhibitors as adjunctive therapy in systolic heart failure, and in patients with a history of myocardial infarction and those having reduced ejection fraction to prevent HF. Perindopril is also approved by FDA for cases of stable coronary artery diseases and it is helpful to reduce the risk of mortality with Myocardial infarction.