[Arterial hypertension, renal function and angiotensin-converting enzyme inhibition].
Several effects of the antihypertensive treatment with angiotensin converting-enzyme inhibitors (ACEI)--whether beneficial or detrimental--are best explained at the renal level. In the presence of a renal artery stenosis, the activation of the intrarenal renin-angiotensin system is first directed at maintaining glomerular filtration and intracapillary hydrostatic pressure through post-glomerular vasoconstriction. Long-term elevation of blood pressure is associated with a shift of the renal function curve, possibly linked with an alteration of the intrarenal renin-angiotensin system. Inhibition of the converting enzyme does affect the mechanisms of sodium conservation. In a subset of essential hypertensive subjects, ACEI may correct a subtle primary abnormality in modulation by sodium of renal (and adrenal) response(s) to angiotensin. Finally, the possibility of renal protection in circumstances such as diabetes mellitus, provides an exciting area of investigations for antihypertensive treatment with ACEI.
Ribstein
J
J
Service de Médecine interne et Néphrologie, Hôpital Lapeyronie, Montpellier.
Mourad
G
G
Mimran
A
A
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D000818:Animals; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000201:enzymology / Q000503:physiopathology*; D006978:Hypertension, Renovascular / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology
D000806:Angiotensin-Converting Enzyme Inhibitors
Hypertension artérielle, fonction rénale et inhibition de l'enzyme de conversion de l'angiotensine.