Tawfic Nessim Abu-Zahra, BSc MSc
Since their introduction into clinical practice 20 years ago, angiotensin converting enzyme (ACE) inhibitors have proven to be safe, well-tolerated drugs, effective in the treatment of a variety of cardiovascular disorders. Large clinical trials have established the efficacy of ACE inhibitors in treating hypertension, in reducing the incidence of myocardial infarction, and in decreasing mortality from heart failure in patients with left ventricular dysfunction.1-5 Additionally, evidence suggests that ACE inhibitors reduce the occurrence and progression of nephropathy in patients with diabetes mellitus.6,7 In two recently published clinical trials of the Heart Out- comes Prevention Evaluation (HOPE) study and the Microalbuminuria, Cardiovascular and Renal Outcomes (MICRO HOPE) substudy, investigators have demonstrated that the ACE inhibitor ramipril (Altace) significantly reduces the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients, including those with diabetes and the elderly.8,9 A brief interview was conducted with Dr. Hertzel C. Gerstein, the principal MICRO HOPE investigator, for the purpose of writing this article. His comments have been included here.
ACE is responsible for the conversion of angiotensin I to angiotensin II (Ang II), the principle hormone mediating the effects of the renin-angiotensin-aldosterone system (RAAS). (Please see Figure 1.
