[Clinical findings with inhibitors of the renin-angiotensin system].
Cardiovascular diseases are often associated with increased activity of the systemic and/or local renin-angiotensin systems. Hence, with respect to the coronary vessels, it has been demonstrated that in patients with severe heart failure inhibition of the renin-angiotensin system with an angiotensin converting enzyme (ACE) inhibitor clearly reduces resistance in the systemic, renal and cardiovascular systems. This reduction in resistance improves the blood supply to the failing heart while, at the same time, diminishing the external workload. It is most likely this effect that contributes towards the improved progression of the underlying disease observed after ACE inhibitor administration. The clinical efficacy of ACE inhibitors in patients who had been subjected to repeated coronary angioplasty has, however, been disappointing. Although these agents exerted a clear inhibitory effect on neo-intima proliferation after balloon dilatation performed on animals, it was not observed in patients with coronary artery disease and did not prevent restenosis. In patients suffering from heart failure there is an increase in sympathetic tone and a decrease in parasympathetic tone. An increase in activity of the renin-angiotensin system produces an increase in sympathetic activity at the level of the peripheral sympathetic synapses and vagus blockage via its effect on the vagal centres in the postremal area. Both effects can be clearly diminished by administering ACE inhibitors. Although high sympathetic tone and low parasympathetic activity are indicators of low life expectancy in heart failure, a clear correlation between the incidence of sudden cardiac death and the changes in autonomic nervous system activity has not yet been established.(ABSTRACT TRUNCATED AT 250 WORDS)
Dietz
R
R
Medizinische Universitätsklinik, Abteilung für Kardiologie, Pulmologie und Angiologie, Heidelberg.
Süsselbeck
T
T
Osterziel
K J
KJ
D000804:Angiotensin II / Q000037:antagonists & inhibitors; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology; D000818:Animals; D001341:Autonomic Nervous System / Q000187:drug effects; D006801:Humans; D012084:Renin-Angiotensin System / Q000187:drug effects*
D000806:Angiotensin-Converting Enzyme Inhibitors; D000804:Angiotensin II
Klinische Erfahrungen mit Hemmern des Renin-Angiotensin-Systems.