Angiotensin-converting enzyme inhibitors in the treatment of heart failure

The article was consulted professionally by Master, Dr. Lu Thi Thuy – Cardiovascular Center – Share99 Central Park International Health Hub

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

Angiotensin-converting enzyme inhibitors, also known as ACEIinhibitors, ace inhibitors, where ACE is the name of the phrase "angiotensin-converting enzyme", meaning angiotensin-converting enzyme. Angiotensin is essentially a protein that causes vascular spasms and hypertension. The group of drugs that inhibit transfer enzymes helps reduce blood pressure by dilating the vessels, reducing peripheral resistance, thereby reducing the pressure on the vessel wall.

ACE inhibitors are the preferred group of drugs in which hypertension is inplace , in addition to this group of drugs are also used in other cases, including:

• Heart failure: Helps reduce the burden on the heart. A decrease in blood pressure will make it easier for the heart to contract blood to feed the body when the heart is impaired. Therefore, the drug can slow the progress of heart failure and prolong the life of the person;
• Myocardial infarction: Helps prevent the risk of myocardial damage caused by anemia and increases the patient's ability to recover from myocardial infarction;
• Diabetic renal disease: Angiotensin-converting enzyme inhibitors slow the progress of renal failure in patients with type 2diabetes , limiting dangerous complications;
• Prevention of cardiovascular disease: For those at high risk for cardiovascular disease, ACEI medications help reduce the risk of myocardial infarction and stroke.

Commonly used angiotensin-converting yeast inhibitors are captopril, enalapril, lisinopril, ramipril, moexipril, perindopril,…

Renin is a substance secreted by near-renal cells (Macula densa cells) when the blood flow to the kidneys decreases, the level of filtration needs the kidneys to decrease (pictured above is due to a decrease in circulation volume, blood pressure drops). It has a reaction that converts angiotensinogen produced in the liver into angiotensin I. Then, thanks to ACE yeast in the lungs, angiotensin I transforms into angiotensin II. Angiotensin II is associated with AT1, AT2, AT3 and AT4 receptors and causes a response. The following three receptors have not been studied much. The AT1 head receptor plays the most important role in the action on blood pressure and is the primary target of angiotensin II. When angiotensin II is associated with the receptor, a response occurs: strengthening sympathy, contraction, activation of the aryeous coridental secretion of aldosterone, increased retention of sodium and water, increased cruiser volume …, these responses all have an increased blood pressure effect.

Ace inhibitors have the effect of inhibiting the action of ACE yeast according to a competitive inhibitory mechanism. When ACE yeast is inhibited, angiotensin II is not produced, the drug produces the following responses:

• Varicose dility: Because ACE is inhibited, angiotensin II decreases and the plasma ADH (anti-diabetes hormone) decreases, reducing peripheral retinal resistance. Selective dilion of important tissues (brain, kidneys, coronary arteries …), redistribution of blood, reduction of burdens, posterity.
• Improves vascular function: Increases elasticity and reduces vascular hypertrocemia.
• Stimulates direct or indirect vice-sympathetic through prostaglandins, which loses the sympathetic reflex of angiotensin II on the pressure reflex arc.
• Reduces hypertrocgestion, fibrosis of the center, inter-septal wall.
• Increased sodium discharge, keeping potassium due to reducing the effect of aldosterone.
• Increased uric acid discharge.
• Increased levels of dialysis due to increased blood flow to the kidneys.
• Increased glucose absorption, sensitivity to insulin.

The above effects help lower blood pressure, protect cardiovascular function …

Ace yeast also has the effect of demoted bradykinin. When ACE is inhibited, bradikinin is not demoted and accumulation leads to a common side effect of this class of drugs that is causing cough. This cough does not respond to central cough relieves and the only way to overcome this side effect is to change the drug

Angiotensin-converting enzyme inhibitors are usually taken 1 hour before eating. Depending on the type of drug and the patient's condition, the doctor will prescribe different dosages and number of uses during the day. During the use of this drug, the patient should be checked for blood pressure and evaluated for liver andkidney function regularly.

In any case, the patient should follow the doctor's instructions for treatment. Do not discontinue the drug abruptly without the consent of a doctor, even if the patient feels that the drug does not work with his or her condition. Especially in the treatment of heart failure,symptoms caused by the disease such as cough, edema, prolonged fatigue … may not improve immediately after taking the drug, but the benefits in the long run have been proven, the drug can prevent heart failure from progressing more severely.

4.1. With other drugs

The use of group drugs that inhibit transfer yeast together with other drugs can affect the effectiveness of treatment:

• Non-steroidal anti-inflammatory drugs (including aspirin, ibuprofen, naproxen…): There is a risk of causing the storage of salt and water in the body, thereby reducing the therapeutic effect of hypertension of the drug that inhibits transfer enzymes;
• Weeds and other hypotensive drugs: Causes co-effects, leading to excessive hypotension of blood pressure;
• Potassium-retaining weeds (including amiloride, spironolactone, triamterene…): The risk of increasing excessive potassium levels.

Therefore, before treatment with angiotensin-converting enzyme inhibitors, patients should inform about the drugs being used so that the doctor prescribes dose reduction or other drug changes to minimize the risk of interaction.

4.2. With food

Use ACE inhibitors along with foods rich in potassium such as bananas, orange juice, vegetables such as spinach, cauliflower, cabbage … can lead to excessive hyperkalemia. Therefore, patients should pay attention to limit the intake of these foods into their daily diet and avoid taking salts with potassium composition.

Patients with heart failure can choose to be treated at Share99 International Health Hub. This gathering a team of cardiovascular specialists including professors, doctors, masters, specialists 2 experienced, have great reputation in the field of medical treatment, surgery, cardiac intervention. Share99 also focuses on applying advanced techniques in the diagnosis and treatment of cardiovascular diseases, using modern medical equipment system, meeting international standards.

Master. Dr. Lu Thi Thuy is currently an interventional cardiologist at Share99 Central Park International Health Hub. Graduated as a General Doctor from Ho Chi Minh City University of Medicine and Pharmacy Ho Chi Minh city in 2010, and graduated with a master's degree in cardiologistry from the University of Sheffield (UK). Dr Thuy Trains cardiovascular practice at the Royal Hallamshire Health Hub. The doctor worked in the Interventional Cardiologist Department, Cho Ray Health Hub from 2012-2016.