The most innovative: new generation ACE inhibitors and the nuances of their use. ACE inhibitors: list of drugs What drugs are ACE inhibitors

ACE inhibitors (from the Latin APF, ACE inhibitors, or angiotensin-converting enzyme inhibitors) are a broad group of medications that block a chemical substance, which affects the narrowing of the walls of blood vessels and an increase in blood pressure.

The use of inhibitors occurs in pathologies of the vascular and cardiac systems, most often in hypertension.

Today, drugs in this group are the most common and affordable, in terms of pricing, drugs that resist high blood pressure.

ACEI, what is it?

The human kidney produces a certain enzyme called renin. It is from this that a series of chemical reactions begin, which lead to the formation of another element in the blood plasma and tissues, called angiotensin-converting enzyme.

The identical name of the latter is angiotensin - it is this that retains the property of narrowing the walls of blood vessels, thereby increasing the speed of blood flow and blood pressure.

Along with this, an increase in its levels in the blood leads to the production of various hormones by the adrenal glands that retain sodium in the tissues, which increases the narrowing of the vascular walls, increasing the number of heart contractions and increasing the volume of fluid inside the human body.

When the above-mentioned processes occur, a vicious circle of chemical reactions is formed, which leads to sustained high pressure and damage to the walls of blood vessels. Such processes ultimately lead to the progression of chronic kidney and heart failure.

It is drugs from the group of ACE inhibitors that help break the vicious chain, blocking processes at the stage of the angiotensin converting enzyme.

The inhibitor promotes the accumulation of a substance such as bradykinin, which prevents the progression of pathological reactions in cells during kidney and heart failure (rapid division, development and necrosis of cells of the heart muscle, kidneys and vascular walls).

Due to their properties, ACE inhibitors are treated not only for hypertension, but also used for preventive purposes, to prevent the death of heart muscle tissue, stroke and heart and kidney failure.

Also, the drugs help improve lipid and carbohydrate metabolism, which allows them to be used quite successfully in diabetes mellitus and in elderly people with lesions of other organs.

Modern ACE inhibitors are among the most effective drugs in the fight against hypertension. Unlike other drugs that dilate blood vessels, they prevent vasoconstriction and have a milder effect.

New generation inhibitors combine well with drugs from other groups, improve blood circulation in the coronary arteries and normalize metabolic processes.

Self-medication can lead to complications.

Classification of ACE inhibitors by generation

The classification of drugs in this group is based on several factors.

The primary division into subtypes occurs according to the initial substance contained in the drug (the main role is played by the active part of the molecule, which ensures the duration of the effect on the body).

This is what helps during the prescription period to correctly calculate the dose and accurately identify the period of time after which you need to re-take the medicine.

Comparative characteristics by generation of ACE inhibitors are given in the table below.

Active group of molecules	Name	Characteristic
First generation (sulfhydryl group)	Captopril, Pivalopril, Zofenopril	The mechanism of action of this group is manifested in enhancing the effect of ACE inhibitors, but it is quite simply oxidized, which allows it to act for a short period of time
Second generation (carboxyl group)	Perindopril, Enalapril, Lisinopril	Characterized by an average duration of action, but are characterized by high permeability in the tissue
Latest generation (phosphinyl group)	Fosinopril, Ceronapril	The drugs are long-acting and have a high rate of permeability into tissue and further accumulation in them

The mechanism of conversion of a chemical into an active substance also helps to classify ACE inhibitors into subgroups.

ACEI	Drug activity
First class drugs (Captopril)	They are dissolved by fats, entering the human body in an active form, converted into the liver cavities and excreted in a modified form, and perfectly pass through cell barriers
Second class drugs (Fosinopril)	They dissolve in fats, are activated during chemical processes in the cavities of the liver or kidneys and are excreted in a modified form. Perfectly absorbed through cell barriers
Third class drugs (Lisinopril, Ceronapril)	They dissolve in water, when they enter the body they occur in an active form, are not converted in the liver, and are excreted intact. Pass more poorly through cell barriers

The final classification occurs according to the methods of elimination by the body.

There are several different methods:

• Excretion occurs primarily by the liver (about sixty percent). An example of such a drug is Trandolapril;
• Excretion occurs by the kidneys. Examples of such ACE inhibitors are Lisinopril and Captopril;
• Excretion occurs primarily by the kidneys (about sixty percent). Examples of such drugs are Enalapril and Perindopril;
• Excretion occurs through the kidneys and liver. Examples are Fozinopril and Ramipril.

This classification helps to select the most suitable ACE inhibitor for people suffering from severe pathologies of the liver or kidney system.

Due to the fact that the generation and class of ACE inhibitor may vary, drugs from the same series may have slightly different mechanisms of action.

Most often, the instructions for use, which contain all the necessary information about the drug, indicate its mechanism of action.

What is the mechanism of action for different diseases?

Mechanism of action of ACE inhibitors in hypertension

Medications interfere with the transformation of angiotensin, which has a clear vasoconstrictor effect. The effect is distributed on plasma and tissue enzymes, which has a mild and long-lasting result in lowering pressure. This is the main mechanism of action of ACE inhibitors.

Mechanism of action in renal failure

The drugs block the production of adrenal enzymes that retain sodium and fluid in the body.

ACE inhibitors help reduce swelling, restore the walls of blood vessels in the renal glomeruli, reduce pressure in them and purify protein in the kidneys.

Mechanism of action in case of heart and vascular failure, ischemia, stroke, death of cardiac muscle tissue

Since, thanks to ACE inhibitors, angiotensin decreases, the amount of bradykinin increases, which prevents the pathological progression of myocardial cells and vascular walls due to lack of oxygen in the heart.

Regular use of ACE inhibitors significantly slows down the process of increasing the thickness of the heart muscle and blood vessels, increasing the size of the heart chambers, which manifest themselves as a result of hypertension.

Mechanism of action of ACE inhibitors in chronic heart failure

Mechanism of action for atherosclerotic deposits and high blood clotting

Since ACE inhibitors release nitric oxide into the blood plasma, platelet clumping is provoked and the level of fibrins (proteins that are involved in the formation of blood clots) is restored.

Medicines have the ability to suppress the production of adrenal hormones, which increase the level of “negative” cholesterol in the blood, which gives them anti-sclerotic properties.

Indications for use of ACE inhibitors

Inhibition has been used in medicine for thirty years. Their active spread in post-Soviet territory began in the 2000s. It is characteristic that since that time, ACE inhibitors have taken a leading place among all blood pressure-lowering drugs.

The main indication for the use of the latest generation inhibitors is hypertension, and the main advantage is the effective reduction in the risk of progression of complications of the heart and blood vessels.

Medicines in this group are used to treat the following diseases:

• Long-term and persistent high blood pressure;
• For symptoms of high blood pressure;
• With high blood pressure, which is accompanied by diabetes;
• Violation of metabolic processes;
• Ischemic lesions;
• Obliterating atherosclerosis of the extremities;
• High blood pressure due to heart failure caused by blood stagnation;
• Kidney pathologies, which are accompanied by increased blood pressure;
• Post-stroke condition with high blood pressure;
• Atherosclerotic deposits in the carotid artery;
• Death of cardiac muscle tissue of an acute nature after normalization of pressure, or a post-infarction state, when the ejection of blood from the left ventricle is less than forty percent, or there are signs of systolic dysfunction, manifested against the background of death of cardiac muscle tissue;
• Obstructive bronchial disease;
• Left ventricular dysfunction of a systolic nature, without taking into account blood pressure levels and recording, or the absence of clinical signs of cardiac dysfunction;
• Atrial fibrillation.

Long-term use of ACE inhibitors entails a significant reduction in the risk of complications in pathologies of cerebral vessels, death of cardiac muscle tissue, heart failure and diabetes.

This is what makes them more advantageous than drugs such as calcium antagonists and diuretics.

With long-term use as the only treatment, replacing beta blockers and diuretics, ACE inhibitors are recommended for the following groups of patients:

• Patients diagnosed with type 2 diabetes;
• People prone to diabetes;
• Patients in whom a beta blocker or diuretic caused side effects or did not have the desired effect.

When using ACE inhibitors as the only therapeutic drug, effectiveness is observed in the first two stages of hypertension and in most young patients.

The effectiveness of such therapy is about fifty percent, which necessitates the parallel use of beta blockers, diuretics, or calcium antagonists.

Complex therapy is used in the third stage of hypertension and in elderly people with concomitant pathologies.

In order to prevent pressure surges from very low to extremely high, the use of the drug is distributed throughout the day.

Doctors do not advise using extremely large doses of ACE inhibitors, as the risk of progression of side effects increases and the tolerability of treatment decreases.

If average dosages of ACE inhibitors are not effective, the best option is to add a diuretic or calcium antagonist to the treatment.

Contraindications for ACE inhibitors

Complications directly affecting the development of the embryo may progress: miscarriage, death inside the womb, congenital defects. Also, it is not recommended to use ACE inhibitors while breastfeeding.

ACEIs are contraindicated for use in patients with the following factors, as listed in the table below.

Contraindications for the use of ACE inhibitors in the presence of pathologies	Factors under which ACE inhibitors are not prescribed
Severe form of narrowing of the aorta	Pregnancy and lactation period
Narrowing of both arteries of the kidneys	Individual intolerance to certain components of the drug
Elevated blood potassium levels	Children's age group
Leukopenia	Atherosclerotic lesions of the coronary arteries of the lower extremities
Systolic pressure is less than one hundred mmHg.	Use of Allopurinol, Indomethacin and Rifampicin
Death of liver tissue
Active hepatitis

Side effects of ACE inhibitors

ACE inhibitors provoke side effects in especially rare cases.

The most common side effects are listed in the table below.

By-effect	Characteristic
Impaired kidney function	There is an increase in creatinine in the blood, sugar in the urine, acute kidney failure may occur (in old age, with heart failure, the kidneys may fail altogether)
Allergic reactions	There is a rash, hives, redness, scabies, swelling
Dry cough	Regardless of dosage, dry cough is observed in twenty percent of patients
Low pressure	Characterized by weakness, lethargy, decreased blood pressure levels, regulated by lowering the dosage of ACE inhibitors and discontinuing diuretics
Effects on the liver	Stagnation of bile in the cavity of the gallbladder progresses
Changes in taste	There is a violation of sensitivity, or a complete loss of taste
Blood count abnormalities	There is an increase in the number of neutrophils
Dyspepsia	Nausea, gag reflex, diarrhea
Deviations in electrolyte balance	Increased potassium levels when using diuretics and potassium-sparing drugs

What drugs are inhibitors?

The list of ACE inhibitor drugs is widely known to a large number of patients. Some patients are indicated to take one drug, while others require combination therapy.

Before prescribing ACE inhibitors, a detailed diagnosis and assessment of the risk of progression of complications is carried out. If there are no risks and there is no need to use medications, a course of therapy is prescribed.

The dose is determined individually by testing. It all starts with a small dose, after which it is removed to a medium one. When starting use, and throughout the entire stage of adjusting the course of treatment, it is necessary to monitor blood pressure until its values ​​normalize.

ACE inhibitors Zocardis

ACE inhibitors list of drugs and analogues

The list is given in the table below and includes the most common drugs and their analogues.

Generation of ACE inhibitors	Name	Similar drugs
First generation	Zofenopril
	Captopril	Capoten, Angiopril, Katopil
	Benazepril	Benzapril
Second generation		Irumed, Diroton, Dapril, Prinivil
	Ramipril	Hartil, Capryl, Dilaprel, Vazolong
	Enalapril	Enap, Renitek, Renipril, Vazolapril, Invoril
	Perindopril	Stoppress, Parnavel, Hypernik, Prestarium
	Cilazapril	Inhibase, Prilazide
	Quinapril	Accupro
	Trandolapril	Gopten
	Spirapril	Quadropril
	Moexipril	Moex
Third generation	Ceronapril
	Fosinopril	Fosicard, Monopril, Fosinap

Natural ACE inhibitors

Medicines from the group of ACE inhibitors, of natural origin, were identified during the study of peptides that are concentrated in the venom of jararaki. These drugs act as coordinators that limit the processes of strong cell stretching.

Blood pressure decreases due to a decrease in peripheral resistance to the walls of blood vessels.

Natural ACE inhibitors enter the human body along with dairy products.

They can be concentrated in small quantities in whey, garlic and hibiscus.

How to use ACE inhibitors?

Before using any medications from the group of ACE inhibitors, you should consult your doctor. In most cases, ACE inhibitors are taken sixty minutes before meals.

The dosage and frequency of use, as well as the interval between taking tablets, should be determined by a qualified specialist.

When treating with inhibitors, it is necessary to eliminate non-steroidal anti-inflammatory drugs (Nurofen), salt substitutes and foods that are rich in potassium.

Conclusion

Medicines from the group of ACE inhibitors are the most common means to combat hypertension, but can also be used to treat other diseases. A wide selection of drugs allows you to choose a product individually for each patient.

In addition to the fact that the drugs effectively combat hypertension, they have a number of side effects. That is why it is not recommended to use ACE inhibitors only after consultation with your doctor.

Do not self-medicate and be healthy!

Angiotensin-converting enzyme (ACE) inhibitors are a group of drugs for the treatment of heart and vascular diseases. Treatment with them significantly reduces the risk of pathologies in this and related areas and reduces mortality rates. Familiarization with the list of ​drugs​ ​ACE inhibitors​ ​with​ ​detailed​ ​descriptions allows you to carry out effective treatment of diseases and avoid serious complications.

What​ ​are​ ​ACE inhibitors

ACE inhibitors (ACE inhibitors) are natural and synthetic chemicals that affect biologically active blood compounds (the renin-angiotensin-aldosterone system). Drugs of this drug group are used for the treatment and prevention of arterial hypertension, kidney failure, heart failure, other vascular and heart pathologies, and diabetes mellitus.

Their effectiveness and widespread use in medicine is due to a wide range of medicinal qualities:

• Antihypertensive properties lead to a sustained decrease in blood pressure. For hypertension, ACE inhibitors are considered the leading drugs of therapy.
• Promote regression of hypertrophy and dilatation of the left ventricular myocardium. ACEI drugs are 2 times more effective than other drugs in reducing the mass of the left ventricle.
• Improvement of coronary, cerebral, renal blood flow.
• Protecting the heart muscle, improving its diastolic function. There is a decrease in myocardial fibrosis. There was a reduction in the risk of sudden death due to myocardial infarction with ACE inhibitor therapy.
• A beneficial effect on the electrical qualities of the heart muscle, which reduces the frequency and severity of extrasystole. The number of ventricular and reperfusion arrhythmias is reduced.
• The angioprotective effect is due to a beneficial effect on the arteries, promoting regression of hypertrophy of the smooth muscle vascular wall, preventing its hyperplasia and proliferation.
• Anti-sclerotic effect on blood vessels by inhibiting the processes of their narrowing and increasing the formation of nitric oxide.
• They improve metabolism in the body: they promote better absorption of glucose by establishing carbohydrate metabolism, have potassium-sparing properties, increase the concentration of “good” cholesterol in the blood, normalizing lipid balance.
• Increased diuresis, stabilization of water metabolism.
• Reducing proteinuria, which is important for patients with diabetes and chronic renal pathologies. Treatment of hypertension with ACE inhibitors in diabetes mellitus as a concomitant pathology is effective.
• Use in plastic surgery for the purpose of protective action against ionizing radiation.

ACE inhibitors can be prescribed in combination with several drugs or be the only drug for treating diseases. Synthetic drugs in this group are represented by an extensive list of pharmacological agents.

Natural ACE inhibitors include foods and plants that have antihypertensive properties: dairy products (due to lactokinin and cazokinin), garlic, hawthorn, etc.

Classification

There is no generally accepted classification of these drugs, since it has no clinical significance. It is common to divide ACE inhibitor drugs into categories based on their chemical structure and the nature of the group that binds to the zinc atom in the ACE molecule:

• sulphihydryl(catopril, zofenopril);
• carboxyl(enalapril, lisinopril, quinapril, etc.);
• phosphonyl(fosinopril);
• natural.

ACE inhibitors also differ in duration of action, which is determined by the frequency of dosing (most are taken once), and in bioavailability (on average, the range of differences is not wide).

There is a classification based on molecular properties:

• Hydrophilic drugs. A faster therapeutic effect is noted due to their rapid dissolution in the blood plasma.
• Hydrophobic(lipophilic). The most pronounced result is observed after administration due to better entry into the cells. Most ACE inhibitors belong to this group.

ACE inhibitor drugs can also be divided into active drugs (little metabolized by the liver, biologically active) and prodrugs (act after absorption in the digestive tract).

List of​ ​drugs

The high effectiveness of the ACE inhibitor group determines their widespread use in medicine and determines the extensive pharmacological list of which​ ​medicines​ ​are​ ​ ​ACE inhibitors. The drug is prescribed immediately after the diagnosis has been established, possible contraindications, and interactions with other medications taken have been assessed.

The choice of ACE inhibitor, its dosage, and duration of therapy is made by the doctor, based on the clinical situation.

Alacepril

A long-acting ACE inhibitor (analogue of Captopril) inhibits ACE by blocking the transition of angiotensin I to angiotensin II, which prevents the vasoconstrictor effect of the latter, promotes vasodilation, and lowers blood pressure. The production of aldosterone II decreases, the excretion of sodium and fluid increases. Does not affect cardiac contractility and heart rate.

Contraindications: hypersensitivity, renal artery stenosis, period after kidney transplantation, cardio- and cerebrovascular pathologies, primary hyperaldosteronism, pregnancy, lactation, children under 14 years of age.

Side effects: dysgeusia, proteinuria, rash, increased creatinine in the blood, leukopenia, agranulocytosis, dyspepsia, hypotension, tachycardia, cough.

Altiopril

Lipophilic drug, is an analogue of Captopril. Stimulates the activity of biological substances that have vasodilating and natriuretic effects. With prolonged therapy, it reduces hypertrophy of the heart muscle and arterial walls, increases blood circulation in the ischemic myocardium.

Contraindications: primary hyperaldosteronism, hypersensitivity, tendency to angioedema when taking ACE inhibitors, pregnancy, lactation.

Side effects: headache, dizziness, depression of the central nervous system, dysfunction of vision, smell, hypotension, paresthesia, arrhythmias, bronchospasm, nonproductive cough, bronchitis, dyspepsia, dysgeusia, abdominal pain, liver dysfunction, kidney dysfunction, stomatitis, hypersensitivity reactions.

Benazepril

The drug is presented in tablet form. This prodrug is converted by hydrolysis into an active substance that reduces the vasoconstrictor effect of angiotensin II and aldosterone secretion. There is a decrease in pre- and afterload on the heart muscle, general peripheral vascular resistance, and varicose veins. The hypotensive effect becomes maximum after a week of therapy.

Contraindications: hypersensitivity to ACE inhibitors, renal artery stenosis, period after kidney transplantation, primary hyperaldosteronism, hypersensitivity, hyperkalemia.

Side effects: dry cough, kidney dysfunction, headache, dizziness, dyspepsia, hyperkalemia, neutropenia, hypersensitivity reactions.

Dynapres

The drug is presented in tablet form. It is a prodrug, after absorption it is converted into 2 metabolites that inhibit ACE, preventing the vasoconstrictor effect of angiotensin II. Under the influence of the drug, aldosterone production decreases and the removal of fluid and sodium from the body increases. A combination of this ACE inhibitor and a diuretic is possible. In this case, the drug is called Dynapres (Delapril/Indapamide). There is also a combination of this ACE inhibitor and a calcium channel blocker - SUMMA (Delapril/Manidipine).

Contraindications: tendency to Quincke's edema when taking ACE inhibitors, aortic valve stenosis, severe renal dysfunction, dehydration, hyperkalemia.

Side effects: hypotension, cough, hyperkalemia, headache, renal dysfunction, dyspepsia.

Zofenopril

The drug is presented in the form of tablets and belongs to the latest generation of modern ACE inhibitors. The prodrug releases the active substance by hydrolysis. Effectively reduces systolic and diastolic blood pressure without affecting cerebral circulation. The description of the drug notes a decrease in patients' total peripheral vascular resistance, post- and preload on the myocardium, platelet aggregation, and improvement of coronary and renal blood flow.

Contraindications: tendency to Quincke's edema when taking ACE inhibitors, porphyria, severe dysfunction of the liver, kidneys, pregnancy, lactation, hypersensitivity, age under 18 years.

Side effects: hypotension, heart attack, arrhythmias, pulmonary embolism, headache, paresthesia, hearing and vision dysfunction, dyspepsia, liver and kidney dysfunction, nonproductive cough, stomatitis, hypersensitivity reactions.

Imidapril

Refers to new ACE inhibitor drugs that affect the renin-angiotensin-aldosterone system. The effectiveness of the drug in the treatment of mild and moderate hypertension and other diseases of the heart and blood vessels has been noted.

Contraindications: pregnancy and lactation, severe kidney and liver dysfunction, a history of angioedema when taking an ACE inhibitor drug.

Side effects: non-productive dry cough not associated with a cold, tachycardia, increased heart rate, headache, liver and kidney dysfunction, dyspepsia, nausea, abdominal pain, dizziness, hypersensitivity reactions.

Captopril

The drug is presented in tablet form. Causes a reduction in angiotensin II, an increase in blood renin activity and a decrease in aldosterone production. An ACE inhibitor with a hypotensive effect reduces blood pressure, improves renal and coronary blood flow, and myocardial blood supply in case of ischemia.

Contraindications: hypersensitivity to ACE inhibitors, significant renal dysfunction, hyperkalemia, period after kidney transplantation, renal artery stenosis, primary hyperaldosteronism, liver dysfunction, hypotension, cardiogenic shock, pregnancy, lactation, age under 18 years.

Side effects: marked drop in blood pressure, dyspepsia, tachycardia, proteinuria, renal dysfunction, headache, dizziness, cough, bronchospasm, hypersensitivity reactions.

Quinapril

The description of the drug indicates its hypotensive and cardioprotective qualities. It is a long-acting medicine, prescribed for the treatment of hypertension and heart failure. With regular use, it reduces total peripheral vascular resistance, blood pressure and pulmonary capillary pressure, while increasing cardiac output. Combined therapy with thiazide diuretics increases the hypotensive effect.

Contraindications: hypersensitivity to ACE inhibitors, pregnancy, lactation, childhood.

Side effects: anemia, thrombocytopenia, leukopenia, bone marrow dysfunction, paresthesia, headache, dizziness, arrhythmia, heart attack, stroke, liver and kidney pathologies, cough, bronchospasm, dyspepsia, abdominal pain, hypersensitivity reactions.

Libenzapril

This ACE inhibitor is a hydrophilic drug. It is characterized by rapid dissolution in blood plasma, which provides a rapid hypotensive effect. This group of inhibitors with high biological activity includes only 4 drugs. Libenzapril is not metabolized and is excreted by the kidneys without changing. However, the systemic bioavailability of drugs in this group is lower compared to lipophilic drugs.

Contraindications: hypotension, hyperkalemia, severe aortic stenosis, pregnancy and lactation, renal artery stenosis, chronic renal failure, hypersensitivity to ACE inhibitors.

Side effects: hypersensitivity reactions, increased creatinine, proteinuria, hyperkalemia, paradoxical increase in blood pressure (with unilateral renal artery stenosis), dyspepsia, abdominal pain, renal dysfunction.

Lisinopril

The drug is indicated for various forms of hypertension and in combination therapy for heart failure. The hypotensive effect is observed an hour after application and becomes maximum after 6 hours. The duration of its storage is a day. When treating hypertension, a stable result develops gradually over 1-2 months. Long-term use of the drug improves the patient's condition, the prognosis of the disease, and reduces mortality.

Contraindications: hypersensitivity to ACE inhibitors, coronary insufficiency, aortic stenosis, coronary heart disease, cerebrovascular pathologies, renal artery stenosis, age under 18 years.

Side effects: hypotension, arrhythmias, headache, dizziness, dyspepsia, abdominal pain, dysgeusia, hyperkalemia, cough, hypersensitivity reactions.

Moexipril

The drug has hypotensive and vasodilating properties. Reduces total peripheral vascular resistance, afterload on the heart, the risk of ischemia and sudden death. With prolonged therapy, hypertrophy and remodeling of the left ventricular myocardium regresses. At the same time, there is no negative effect of the drug on lipid, carbohydrate, and electrolyte metabolism. Used for the treatment of hypertension in postmenopause.

Contraindications: hypersensitivity to ACE inhibitors, pregnancy, lactation. Used with caution in cases of aortic stenosis, cardio- and cerebrovascular pathologies, renal artery stenosis, severe renal and liver failure, and under the age of 18 years.

Side effects: hypotension, arrhythmias, coronary heart disease, headache, dizziness, stroke, bronchospasm, cough, dyspepsia, abdominal pain, stool disorders, intestinal obstruction, hyperkalemia, myalgia, kidney dysfunction, hypersensitivity reactions.

Perindopril

The drug has vasodilating, cardioprotective, and natriuretic properties. Reduces total peripheral vascular resistance, afterload on the heart muscle, and resistance in the pulmonary vessels. There is an increase in cardiac output, development of tolerance to physical activity, and sensitization of peripheral tissues to insulin. The antioxidant effect of the drug is observed.

Contraindications: hypersensitivity to ACE inhibitors, pregnancy, lactation, childhood, used with caution in case of cardio- and cerebrovascular pathologies, in the period after kidney transplantation, with bilateral stenosis of the renal arteries, hyperkalemia, dehydration.

Side effects: cough, headache, dyspepsia, dysgeusia, pancreatitis, hypotension, bronchospasm, renal dysfunction, stomatitis, hypersensitivity reactions.

Ramipril

The drug is presented in the form of tablets to be taken once a day. Inhibits the vasoconstrictor effect of angiotensin II, reduces the production of aldosterone. Increases the effect of renin in plasma. Indicated for the treatment of persistent increases in blood pressure, congestive heart failure, and for the prevention of sudden death in the post-infarction period.

Contraindications: hypersensitivity to ACE inhibitors, stenosis of the renal arteries, the period after their transplantation, cardio- and cerebrovascular pathologies, primary hyperaldosteronism, pregnancy, lactation, severe kidney and liver dysfunction, age up to 14 years.

Side effects: hypotension, arrhythmia, collapse, exacerbation of coronary heart disease, renal dysfunction, dyspepsia, neurological pathologies (headache, paresthesia, dizziness and others), hypersensitivity reactions.

Spirapril

The active metabolite after biotransformation of the drug in the liver is spiraprilat, which has hypotensive, natriuretic, and cardioprotective properties. The drug improves the functioning of the heart muscle and develops its tolerance to physical activity. The cardioprotective effect promotes regression of hypertrophy and dilatation of the left ventricle.

Contraindications: hypersensitivity to ACE inhibitors, hypotension, hyperkalemia, pregnancy, lactation, age under 18 years.

Side effects: hypotension, anemia, leukopenia, thrombocytopenia, dyspepsia, dysgeusia, stomatitis, glossitis, sinusitis, liver and kidney dysfunction, headache, dizziness, paresthesia, cough, bronchospasm, hypersensitivity reactions.

Temocapril

The drug has pronounced antihypertensive properties. Promotes regression of left ventricular hypertrophy, improves electrical parameters of the myocardium, adjusting heart rhythm. There is an increase in coronary blood flow and blood supply to the ischemic heart muscle.

Contraindications: hypersensitivity to ACE inhibitors, severe aortic stenosis, hypotension, pregnancy, lactation, hyperkalemia, renal artery stenosis.

Side effects: bone marrow dysfunction, hypersensitivity reactions, dyspepsia, liver dysfunction, stool disorder, dysgeusia, activation of prostaglandin production, cough, hyperkalemia.

Trandolapril

A prodrug whose active metabolite, after hydrolysis, is trandolaprilat. Effectively reduces blood pressure, total peripheral vascular resistance, afterload on the heart muscle, dilates veins to some extent, and reduces preload. There is no reflex increase in heart rate. Improves renal and coronary blood flow, diuresis, and has potassium-sparing properties.

Contraindications: hypersensitivity to ACE inhibitors, pregnancy, lactation.

Side effects: nonproductive cough, rhinitis, sinusitis, headache, dysgeusia, cardio- and cerebrovascular pathologies, dyspepsia, abdominal pain, liver and kidney dysfunction, decreased potency, hyperkalemia, hypersensitivity reactions.

Fosinopril

Upon entering the body, it is metabolized into fosinoprilat, which has antihypertensive, natriuretic, vasodilating, and cardioprotective properties. The hypotensive effect is observed throughout the day. During therapy with this drug, a dry, unproductive cough is less likely to occur.

Contraindications: hypersensitivity to ACE inhibitors, hypotension, severe renal dysfunction, hyperkalemia, pregnancy, lactation. Use with caution for cardio- and cerebrovascular pathologies, bone marrow suppression, chronic obstructive pulmonary disease, hepatitis, cirrhosis, in childhood and old age.

Side effects: cardio- and cerebrovascular pathologies, arrhythmia, hypotension, dyspepsia, stool disorders, abdominal pain, headache, paresthesia, cough, bronchospasm, hypersensitivity reactions.

Quinapril

The drug has antihypertensive, cardioprotective, natriuretic properties. Inhibits ACE in plasma, tissues of the lungs, heart, blood vessels, kidneys, but does not affect the activity of the enzyme in the brain and testicles. Promotes the expansion of the peripheral vascular network, improves regional blood flow, reduces total peripheral vascular resistance and afterload on the heart muscle. Inhibits the formation of nephrosclerosis (especially with concomitant diabetes).

Contraindications: hypersensitivity to ACE inhibitors, pregnancy, lactation. Use with caution in case of cardio- and cerebrovascular pathologies, severe renal dysfunction, chronic obstructive pulmonary disease, dehydration, hypotension.

Side effects: hypotension, cardio- and cerebrovascular pathologies, dyspepsia, liver and kidney dysfunction, headache, hypersensitivity reactions.

Cilazapril

The pharmacologically active metabolite is cilazaprilat, which has a pronounced hypotensive effect. It is observed an hour after administration, the maximum is determined after 3-7 hours and lasts for a day. A stable therapeutic effect is observed after 2-4 weeks of treatment. In chronic heart failure, it reduces pre- and afterload on the myocardium when taken together with diuretics. Increases life expectancy and quality of life.

Contraindications: hypersensitivity to ACE inhibitors, ascites, aortic stenosis, pregnancy, lactation.

Side effects: cough, headache, dizziness, anemia, leukopenia, increased creatinine, potassium, urea in the blood, hypersensitivity reactions.

Enalapril

A common, frequently prescribed drug with antihypertensive and vasodilating properties. Effectively blocks ACE, inhibits the production of aldosterone by the adrenal glands. Refers to prodrugs; during the process of hydrolysis, the active substance is formed - enalaprilat. Some diuretic properties of the drug are noted. Improves respiratory function, blood circulation in the pulmonary circulation, reduces pre- and afterload on the heart muscle, and resistance in the blood vessels of the kidneys.

Contraindications: hypersensitivity to ACE inhibitors, renal dysfunction, primary hyperaldosteronism, hyperkalemia, renal artery stenosis, azotemia, pregnancy, lactation, childhood.

Side effects: hypotension, cough, headache, dyspepsia, heart pain, abdominal pain, kidney and liver dysfunction, hypersensitivity reactions.

Indications

ACE inhibitor drugs are prescribed for the following indications:

• Arterial hypertension and hypertension, especially in the presence of diabetes mellitus, heart failure, bronchial obstruction, obliterating atherosclerosis of the vessels of the legs, hyperlipidemia.
• Coronary heart disease, including post-infarction cardiosclerosis.
• Impaired functioning of the left ventricle, including asymptomatic ones.
• Chronic heart failure.
• Secondary kidney damage in diabetes, chronic pyelonephritis, glomerulonephritis, hypertensive nephropathy.

Mechanism of action

The therapeutic effect of drugs of this drug group is due to their effect on the renin-angiotensin-aldosterone system. The purpose of the drug taken is to block ACE, an angiotensin-converting enzyme that converts the hormone angiotensin I into angiotensin II. The latter has a negative effect on the human body:

• provokes a narrowing of blood vessels;
• causes the adrenal glands to release aldosterone, under the influence of which fluid and salts are retained in the tissues.

When ACE converts angiotensin I into angiotensin II, there is an increase in blood pressure. The mechanism of action of ACE inhibitors is aimed at preventing the production and reduction of this hormone in the blood and tissues by suppressing ACE. ACE inhibitor drugs can enhance the effect of diuretics, reducing the body's ability to produce aldosterone in conditions of reduced fluid and salt levels. ACE inhibitors positively change the balance of biologically active substances in the body, reduce the hyperactivity of the sympathetic nervous system, effectively lower blood pressure, and prevent the development of dangerous diseases and conditions.

Methods of administration

The dosage of the drug and the frequency of administration are determined by the doctor, based on the patient’s condition, examination results, and the body’s response to the therapy. Medicines in this group are taken on an empty stomach one hour before meals. During treatment, it is recommended to limit the consumption of salt substitutes and large amounts of potassium-rich foods.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce the effectiveness of ACE inhibitors, for this reason you should not combine them. The course of therapy should not be interrupted even if the condition has stabilized and there are no symptoms. When treating chronic heart failure, long-term medication is often required.

When treating ACEIs, it is necessary to regularly monitor blood pressure, assess kidney function (creatinine, potassium), the patient’s clinical condition, and side effects.

Contraindications

Contraindications for taking ACE inhibitor drugs include:

• pronounced individual hypersensitivity, tendency to angioedema during therapy with ACE inhibitors;
• renal artery stenosis, decreased renal function (creatinine over 300 µmol/l);
• severe aortic stenosis, arterial hypotension;
• excessive increase in potassium in the blood (more than 5.5 mmol/l);
• pregnancy and lactation;
• childhood.

The drugs are used with caution in cases of low systolic pressure (below 90 millimeters of mercury), renal failure (creatinine up to 300 µmol/l), with exacerbation of hepatitis, cirrhosis, severe anemia, agranulocytosis, thrombocytopenia.

Side effects

ACE inhibitor drugs are well tolerated and have low severity of negative consequences from taking them.

Side effects of therapy include:

• Dizziness, weakness. Usually observed at the beginning of therapy, while taking diuretics.
• Hypotension, tachycardia, rarely cardio- and cerebrovascular pathologies.
• Dyspepsia, vomiting, stool disorders, liver dysfunction.
• Transient taste disturbances, salty or metallic taste in the mouth.
• Changes in peripheral blood parameters (thrombopenia, anemia, leukopenia, neutropenia).
• Angioedema, rash, skin hyperemia.
• A cough may occur when​ ​taking​ ​ACE inhibitors. If the symptom is not associated with another cause, discontinuation of therapy or change of drug is required. Unfortunately, an ACE inhibitor that does not cause cough has not yet been developed. This negative effect can develop when taking any drug in this group. However, better tolerability of Fosinopril in this regard was noted compared to other ACE inhibitors.
• Sore throat, chest, bronchospasm, voice change, stomatitis, fever, swelling of the lower extremities.
• Increased potassium in the blood. It manifests itself as confusion, irregular heart rhythm, numbness or tingling of the limbs, lips, shortness of breath, and heaviness in the legs.
• Impaired kidney function.
• Paradoxical increase in blood pressure (with pronounced narrowing of the renal artery).

In the article we will consider a list of ACE inhibitor drugs.

Hypertension is a common disease of the cardiac system. Often, an increase in blood pressure can be provoked by the influence of inactive angiotensin I. In order to prevent its influence, drugs that inhibit the effect of this hormone are included in the treatment regimen. These medications are inhibitors. The following is a list of the latest generation ACE inhibitors.

What kind of drugs are these?

ACE inhibitors belong to a group of synthetic and natural chemical compounds, whose use has helped achieve success in the treatment of patients with vascular and cardiac pathologies. ACEs have been used for more than forty years. The very first medicine was Captopril. Next, Lisinopril and Enalapril were synthesized. Then they were replaced by new generation inhibitors. In the field of cardiology, such drugs are used as the main agents that have a vasoconstrictor effect.

The benefit of the latest ACE inhibitors is the long-term blocking of a special hormone, which is angiotensin II. This hormone is the main factor influencing the increase in a person’s blood pressure. In addition, angiotensin-converting enzyme drugs can prevent the breakdown of bradykinin, helping to reduce the resistance of efferent arterioles, they also release nitric oxide and increase the concentration of vasodilatory prostaglandin.

New Generation

In the pharmacological group of ACE inhibitors, drugs that must be taken repeatedly (for example, Enalapril) are considered obsolete, since they cannot provide the required effect. True, Enalapril still remains a popular drug that demonstrates excellent effectiveness in the treatment of hypertension. In addition, there is no confirmed evidence that the latest generation of ACE drugs (for example, drugs such as Perindopril, Fosinopril, Ramipril, Zofenopril and Lisinopril) have much more advantages over their analogues , released forty years ago.

The list of ACE inhibitor drugs is quite extensive.

Vasodilator drugs ACE

Vasodilator drugs ACEs in cardiology are often used to treat arterial hypertension. Here is a comparative description and list of ACE inhibitors that are the most popular among patients:

• The drug "Enalapril" is an indirect cardioprotector that quickly reduces blood pressure and reduces the load on the heart. This remedy acts on the body for up to six hours and is usually excreted by the kidneys. Rarely can cause decreased vision. The cost is 200 rubles.
• "Captopril" is a short-acting agent. This drug stabilizes blood pressure well, although this drug may require multiple doses. The dosage is determined by the doctor. The drug has antioxidant activity. In rare cases, it can provoke tachycardia. Its cost is 250 rubles.
• The medicine "Lisinopril" has a long duration of action. It works completely independently and does not need to be metabolized in the liver. This medicine is excreted by the kidneys. The drug is suitable for all patients, even those suffering from obesity. It can be used in patients with chronic kidney disease. This drug may cause headaches along with ataxia, drowsiness, and tremor. The cost is 200 rubles.
• The medication "Lotensin" helps lower blood pressure. This drug has vasodilating activity. It leads to a decrease in bradykinin. This product is contraindicated in nursing and pregnant women. The drug is rarely capable of causing vomiting with nausea and diarrhea. The cost of the medicine is within 100 rubles.
• The drug "Monopril" slows down the metabolic processes of bradykinin. The effect of its use is usually achieved after three hours. This drug is not addictive. It should be prescribed with caution to patients with chronic kidney disease. The cost is 500 rubles.
• The drug "Ramipril" is a cardioprotector that produces ramiprilat. This medication reduces peripheral vascular resistance and is contraindicated in the presence of arterial stenosis. The cost is 350 rubles.
• The drug "Accupril" can help lower blood pressure. This medicine may relieve resistance in the pulmonary vessels. Quite rarely, this drug can cause vestibular impairment and loss of taste (side effects of ACE inhibitors). The average price is 200 rubles.
• The drug "Perindopril" helps the active metabolite to form in the human body. Its maximum effectiveness can be achieved within three hours after application. Rarely, it can cause diarrhea with nausea and dry mouth. The cost is 400 rubles. The list of latest generation ACE inhibitor drugs does not end there.
• The drug "Trandolapril" with long-term use reduces the severity of myocardial hypertrophy. An overdose of the drug can cause severe hypotension along with angioedema. The cost is 100 rubles.
• The drug "Quinapril" affects renin-angiotensin functions. This drug significantly reduces the load on the heart. It is very rarely capable of causing an allergic reaction and costs 360 rubles.

Not everyone knows what ACE inhibitor drugs are.

Classification

There are several inhibitory classifications. These drugs are classified depending on the method of removing them from the body and their activity. Modern medicine widely uses the chemical ACE classification of drugs, which includes the following groups:

• sulfhydryl group;
• carboxyl group (we are talking about dicarboxylate-containing drugs);
• phosphinyl group (phosphonate-containing medications);
• group of natural compounds.

Sulfhydryl group

ACE inhibitors of this group act as calcium antagonists.

Here is a list of the most famous medications from the sulfhydryl group:

• "Benazepril";
• "Captopril", along with "Epsitron", "Capoten", and "Alkadil";
• "Zofenopril" and "Zocardis".

Carboxyl group

This category of medications has a positive effect on the lives of patients with hypertension. These medications are used only once a day. They should not be taken if you have coronary heart disease, diabetes mellitus or renal failure. Here is a list of the most famous drugs from this group: “Perindopril” along with “Enalapril”, “Lisinopril”, “Diroton”, “Lisinoton”, “Ramipril”, “Spirapril”, “Quinapril” and so on. Mostly, such drugs are used to treat kidney failure and hypertension.

Phosphonate-containing inhibitors

These drugs have a high ability to penetrate the tissues of the human body; thanks to their use, the pressure is usually stabilized for a long period. The most popular drugs from this group are Fosinopril and Fosicard.

Your doctor will help you choose the best ACE inhibitors.

Natural inhibitors of the latest generation

Such means are original coordinators that limit the process of strong cell stretching. Blood pressure decreases while taking them due to a decrease in vascular peripheral resistance. Natural inhibitors that enter the body with dairy products are called cazokinins and lactokinins. They are found in small quantities in garlic, whey and hibiscus.

Indications for use

The latest generation products presented above are used today even in plastic surgery. True, they are more often prescribed to patients to lower blood pressure and to patients with disturbances in the functioning of the heart and blood vessels for the treatment of arterial hypertension. It is not recommended to use these medications on your own, as they have many contraindications and side effects. The main indications for the use of these drugs are the following pathologies:

• the patient has diabetic nephropathy;
• with dysfunction of the left ventricle of the heart;
• against the background of the development of atherosclerosis of the carotid arteries;
• against the background of myocardial infarction;
• in the presence of diabetes mellitus;
• against the background of obstructive bronchial disease;
• in the presence of atrial fibrillation;
• against the background of metabolic syndrome.

The latest generation of ACE inhibitors are used very often today.

Use for hypertension

These drugs effectively block angiotensin-converting enzymes. These modern medicines have a positive effect on human health and protect the kidneys and heart. Among other things, inhibitors have found wide use in diabetes mellitus. These medications increase cellular sensitivity to insulin, improving glucose uptake. As a rule, all new medications for hypertension are taken once a day. Here is a list of modern inhibitors that are widely used for hypertension: “Moexzhril” along with “Lozhopril”, “Ramipril”, “Talinolol”, “Fisinopril” and “Cilazapril”.

The list of latest generation ACE inhibitors goes on.

Inhibitors for heart failure

Often, treatment of chronic heart failure involves the use of inhibitors. This category of cardioprotectors in blood plasma prevents the transformation of inactive angiotensin I into active angiotensin II. Thanks to this, its adverse effects on the kidneys, heart and peripheral vascular bed are prevented. Here is a list of cardioprotective drugs approved for heart failure: Enalapril along with Captopril, Verapamil, Lisinopril and Trandolapril.

Mechanism of action of inhibitors

The mechanism of action of inhibitors is to reduce the activity of angiotensin-converting enzymes, which accelerate the transition of inactive angiotensin to active. These drugs inhibit the breakdown of bradykinin, which is considered a powerful vasodilator. These medications reduce blood flow to the heart, reducing strain and protecting the kidneys from the effects of diabetes and hypertension.

Taking modern inhibitors

Many patients with hypertension are often interested in how to properly take new generation ACE inhibitors? Answering this question, it must be said that the use of any drugs in this group must necessarily be agreed with a doctor. Typically, inhibitors are taken an hour before meals, that is, on an empty stomach. Dosage, frequency of use and interval between doses are determined by a specialist. During therapy with inhibitors, it is necessary to avoid anti-inflammatory non-steroidal medications and foods rich in potassium.

Inhibitors and contraindications to their use

The list of relative contraindications for the use of inhibitors is as follows:

• the patient has moderate arterial hypotension;
• presence of chronic severe renal failure;
• in childhood;
• in the presence of severe anemia.

Absolute contraindications include hypersensitivity, lactation, bilateral renal artery stenosis, severe hypotension, pregnancy and hyperkalemia.

People may experience side effects from ACE inhibitors in the form of itching, allergic rash, weakness, hepatotoxicity, decreased libido, stomatitis, fever, rapid heartbeat, swelling of the legs and so on.

Side effect

Long-term use of these drugs can lead to inhibition of hematopoiesis. As a result, the content of red blood cells, leukocytes and platelets in the blood decreases. Therefore, during the treatment period, regular repetition of a general blood test is required.

Allergic reactions and intolerances may also develop. This usually manifests itself as itching, redness of the skin, urticaria, and photosensitivity.

In addition, the function of the digestive system may be impaired, which will lead to distortion of taste, nausea and vomiting, and discomfort in the stomach. Sometimes people suffer from diarrhea or constipation, and the liver stops working normally. In some cases, ulcers (aphthae) occur in the mouth.

The tone of the parasympathetic nervous system can be enhanced by drugs, and the synthesis of prostaglandins can also be activated. A dry cough occurs and the voice changes. Symptoms can be alleviated by taking non-steroidal anti-inflammatory drugs, but not by using antitussives. If patients have a pronounced increase in blood pressure, a paradoxical increase in blood pressure cannot be ruled out. Hyperkalemia occurs in some cases, and fractures of limb bones due to falls occur more often.

The article reviewed the latest generation of ACE inhibitors.

Chemical compounds for the treatment and prevention of heart disease are called angiotensin-converting enzyme inhibitors(APF). Modern inhibitors make it possible to effectively treat many diseases, from hypertension to heart failure.

The principle of action is that the drug blocks angiotensin, which is responsible for vasoconstriction. Angiotensin causes the adrenal glands to produce aldosterone, which in most cases causes the above diseases.

Classification of ACE inhibitors

All drugs in this group are divided into several types. They are all different from each other and are designed to treat a specific disease. There is also a difference in the generation of the medicine; more modern versions are more effective.

There are about four types of inhibitors in total, they look like this:

1. sulfhydryl group inhibitors;
2. carboxyl group;
3. phosphinyl group;
4. natural inhibitors.

• The above species are designated active, Because they have biological activity, each of these species performs the same function of inhibiting angiotensin, but does so with a different method of entry and exit from the body.
• They can also accumulate in cells differently. Each drug has a positive effect on the condition of the myocardium and the entire body as a whole.
• There are also other ACE drugs, which are inactive substances and are called prodrugs. Their action is activated only after absorption from the gastrointestinal tract as a result of hydrolysis, and it is also possible that metabolism occurs in the liver.
• These include all dosage forms not fitting the description of active groups. Based on this, several classes are formed, which differ in the method of absorption and speed of action.

List of drugs

There are instant-acting drugs that will help with an attack of hypertension, as well as drugs that can be used for long-term therapy without negative effects. This is achieved due to different rates of absorption, for example, the common drug capoten is absorbed from the gastrointestinal tract within an hour, then it is excreted by the kidneys.

Detailed list of drugs that can help for hypertension:

This list is incomplete, because more and more effective new generation drugs are being produced every day. The medications provided have been tested, but consultation with a specialist is required before taking them.

They also have the following contraindications: impaired renal function, severe vascular atherosclerosis; they are used with caution in diabetes mellitus.

In a similar article you will find even more

Pharmacological properties

• Any ACE inhibitor is a unique medicine, as it helps to normalize the concentration of potassium and magnesium ions, which in turn leads to an improvement in the transport systems of cell membranes.
• At the same time, the heart muscle begins to work more actively (if she was previously in a depressed state), this allows her to better tolerate physical activity.
• The main property is the vasodilating effect. With a long course of arterial hypertension, when the myocardium of the left stomach is slightly hypertrophied, an ACE inhibitor can help, and the hypertrophied part will regress.
• Blood circulation of all organs significantly improves, if the brain has experienced oxygen starvation for a long time due to constricted blood vessels associated with angiotensin, then the problem will be solved.
• It is very important that this medicine can interact with other drugs for the complex treatment of serious diseases.

Based on the above, inhibitors can affect approximately 4 areas in the body:

1. Impact on the cardiovascular system in the form of improvements in functioning and general condition.
2. Effect on the kidneys, here ACE improves diuresis, reduces the migration of macrophages and monocytes.
3. Neurohumoral effects in the form of suppression of angiotensin, decreased activity of the sympathetic-adrenal system.
4. The effects on cells are manifested in improved glucose metabolism and anti-inflammatory effects.

Indications for use

First of all, any diagnosed vasoconstriction disease that is associated with angiotensin type 1 or 2 is an indication for use.

A more detailed list of diseases for which this type of medication is prescribed:

For many diseases, the medicine acts as a component of complex therapy or as a drug to relieve attacks. With a fairly simple course of the disease, it can be used as monotherapy.

It is very important that a person with periodic attacks of hypertension has this drug, as it can significantly ease the course of the attack.

List of latest generation drugs that will help with an attack:

• zofenopril;
• fosinopril;
• lasinopril

Their advantages are that part of the drug is subsequently excreted by the liver, which allows them to be used by those people who have kidney failure.

Contraindications

In general, the drug is well tolerated, but, like any other drug, it has its own contraindications.

General list of contraindications:

• pregnancy and breastfeeding;
• aortic stenosis;
• severe diuresis (this can lead to a severe drop in blood pressure);
• renal failure (now it is possible to take new generation inhibitors);
• stenosis of the artery of a single kidney;

There may be other contraindications that can only be identified by a doctor.

There are also diseases for which the medicine should be used with great caution, these include the following diseases:

1. various autoimmune diseases;
2. impaired renal and liver function;
3. elderly age.

It is impossible to prescribe an ACE drug yourself, since a prescription is required to purchase it. The doctor will conduct a full examination and take a medical history before prescribing it.

If there are contraindications, but the benefit is greater than the possible harm, then the medicine will be used under strict control.

Side effects

If you follow the dosage that is indicated in the instructions or was individually selected by your doctor, the frequency of side effects is very low. Tablet forms are characterized by body reactions in the form of nausea and intolerance.

In medical practice, the following side effects have been recorded while taking the drug:

• while taking it, hypotension may develop (a condition opposite to high blood pressure);
• normal kidney function may be disrupted;
• headache and dizziness appear;
• nausea and loss of appetite;
• various allergic reactions;
• When using higher dosages, arterial hypotension is possible.

Overall, worsening condition can be very pronounced if a person had a serious pathology before taking it, for example, in most cases, kidney dysfunction was recorded in people with a disease that already existed before taking the drug.

ACE inhibitors for diabetes mellitus They do an excellent job with the task assigned to them, but if there is serious damage to the kidneys and other organs due to a primary disease, then taking them can cause serious consequences. Some people may also experience a cough while taking inhibitors.

Mechanism of action

The mechanism of action of the drug is well studied, so it is possible to delve into the details of how the drug works.

Inhibitors act as follows:

In simple terms, it simply prevents the hormone angiotensin from creating a vasoconstrictor effect.

Also, the effect on bradykinin allows you to significantly dilate blood vessels, thereby increasing the effectiveness of the drug.

Bradykinin is a peptide that, in large quantities, lowers blood pressure.

This combined effect is unique, which is why ACE blockers are widely valued in the treatment and relief of attacks of many diseases. Since blood vessels can dilate significantly when taking the drug, you should be prepared for low blood pressure if you are predisposed to it.

Advantages of drugs and their effectiveness

• Direct analogues of this type of medicine practically none, which means that there is nothing to compare them with, but even under such conditions they have a lot of advantages.
• The most important thing is that that with the help of the drug you can provide both quick help to relieve symptoms and carry out long-term therapy, ACE inhibitors are a universal medicine.
• Currently available on the market combined ACE inhibitors, which can act as both a diuretic and an antihypertensive agent.
• Medicine is preferred for a variety of heart diseases compared with other antihypertensive agents. It has a milder effect and, together with therapy, provides prevention and improvement of general condition. The ability of cells to absorb glucose is greatly increased; in diabetes mellitus, this can help reduce insulin dosages.
• New generation of medicines can be used even for serious kidney problems; this is an undeniable advantage for people who have only one kidney or have serious pathologies with this organ.

Prices for drugs

This group of medicines can be found in any large pharmacy; prices will depend on the city, as well as on the brand representing the drug.

Throughout Russia, prices may vary slightly, here is the approximate cost of the most common medications:

• renepril has a cost of 50 rubles for 20 tablets;
• parnavel has value from 200 to 400 rubles for 30 pieces (unlike the first medicine, it has a longer effect);
• monopril has a cost of up to 450 rubles for 28 tablets (it is used by people who have kidney problems);
• amprilan has a cost of up to 200 rubles for 30 pieces (used in the complex treatment of hypertension, coronary heart disease, and can be used for kidney problems);
• hood has a cost of up to 200 rubles for 40 pieces (used for mild hypertension and to relieve attacks, since it does not cause side effects with a one-time use).

Your doctor will help you choose the exact drug; he will be able to identify possible side effects that may only occur in you; by monitoring your intake, he will be able to replace the drug with another, more suitable one.

The medications provided will help solve the problem of hypertension and other diseases in different ways, but in order not to have to use them, you must always follow preventive measures.

General prevention of most diseases includes: maintaining immunity, physical exercise, regular examinations, taking medications that improve the condition of the body. If a disease is detected, it is very important not to self-medicate; you should immediately see a doctor and then follow his recommendations.

Hello, dear friends!

When I saw that the article turned out to be impressive (don’t be alarmed, I divided it into two parts), I poured myself some tea with lemon balm, took out two Korovka candies so that the material could be absorbed better, and started reading.

And you know, it captivated me so much! Many thanks to Anton: he explained everything so interestingly and clearly!

Plunging into the mysterious world of the human body, I never cease to admire how magically Man is created.

It was necessary for the Creator to come up with everything like that! One substance combines with another, a third helps it in this, while something expands, something contracts, something is released, something improves. Moreover, this entire factory works non-stop, day and night!

In general, friends, pour yourself some tea or coffee to complete the buzz (if your blood pressure is OK) and read with feeling, sense, and alignment.

And I give the floor to Anton.

- Thank you, Marina!

Last time we talked to you about how the nervous system regulates blood pressure, and we talked about drugs that affect this process.

Today we will discuss the factors that regulate vascular tone, that is, we will talk about humoral regulation of blood vessels, which is nothing more than regulation by signaling molecules.

Humoral regulation of blood vessels

Humoral regulation is much more ancient and therefore more complex both in description and in understanding.

Let's take a closer look at substances that increase vascular tone.

The first and most famous - adrenalin. This is a hormone of the adrenal cortex, which is released when exposed to the sympathetic nervous system.

The mechanism of its action is associated with the effect on adrenergic receptors, which we already discussed last time. Therefore, you already know what to do with the effect of adrenaline on blood vessels.

The following connection is angiotensin II. This is a powerful vasoconstrictor compound that is formed as a result of a chain of transformations: angiotensinogen - angiotensin I - angiotensin II.

Angiotensinogen is an inactive compound produced in the liver. These transformations are catalyzed by the so-called angiotensin converting enzyme , or simply APF. ACE activity is regulated, in turn, by renin. Remember? We also talked about this.

This substance is secreted by the kidney in response to the influence of sympathetic innervation on it. In addition, the kidney begins to produce renin if the amount of blood supplied to it decreases.

Angiotensin II also affects the adrenal glands, stimulating the release of aldosterone and cortisol – hormones that reduce sodium excretion.

This happens normally.

What happens during stress?

Now imagine a person who experiences chronic stress.

For example, our colleague is a senior manager who deals with difficult clients every day.

During every stressful situation, the sympathetic nervous system is activated. The blood vessels narrow, the heart begins to beat faster, a portion of adrenaline is released from the adrenal glands, and the kidneys begin to secrete renin, which activates ACE.

As a result, the amount of angiotensin II increases, the vessels narrow even more, and the pressure jumps.

If the stress has passed, the activity of the sympathetic nervous system decreases, and gradually everything returns to normal.

However, if the stress is repeated day after day, the blood flow of the kidneys under the influence of adrenaline and angiotensin II becomes worse and worse, the kidneys release even more renin, which promotes even more release of angiotensin II.

This causes the heart to exert more and more force to pump blood into the narrowed arteries.

The myocardium begins to grow. But no one will increase his nutrition, since only muscles grow, not blood vessels.

In addition, large amounts of angiotensin II release aldosterone from the adrenal glands, which reduces sodium excretion, and sodium attracts water, which increases blood volume.

There comes a moment when the heart refuses to work in such conditions and begins to “scandalize” - arrhythmias appear, its contractility decreases, as the heart muscle loses its last strength in trying to pump blood into the narrowed vessels.

The kidneys are also not happy: the blood flow in them is disrupted, the nephrons gradually begin to die.

That is why hypertension entails several complications at once.

And stress is to blame for everything. It is no coincidence that hypertension is called “the disease of unspoken emotions.”

In the same way, any factor that narrows the lumen of the renal artery will work, for example, a tumor compressing the vessel, or an atherosclerotic plaque, or a blood clot. The kidney will “panic” because it lacks oxygen and nutrients, and will begin to release renin in huge portions.

Have I not loaded you too much with physiology?

But without understanding this it is impossible to understand the effect of the drugs to which I now turn.

So, How can all this disgrace be affected by medications?

Since the central link in this story is angiotensin II, it is necessary to somehow reduce its amount in the body. And here drugs that reduce the activity of ACE, or (ACEI), come to the rescue.

ACE inhibitors

Drugs in this group have a vasodilating effect, inhibit the excretion of protein in the urine, and have a diuretic effect (due to the fact that they dilate blood vessels, including those of the kidneys, and reduce the amount of aldosterone). In addition, they reduce the excretion of potassium by the kidneys. The effectiveness of drugs in this group has been proven for heart failure and left ventricular hypertrophy, since they reduce the activity of cardiac muscle growth.

For a long time, this group of drugs was considered the “gold standard” for the treatment of hypertension. Why? Look: the blood vessels are dilated, the work of the heart is made easier, the kidneys are also happy.

And these drugs also helped reduce mortality from myocardial infarction. It would seem, what more could you want?

The main side effect noted by patients is a dry cough.

In addition, ACE inhibitors cause hypotension (in the case of a single dose of large doses), can provoke the appearance of a rash, loss of taste sensitivity, impotence and decreased libido, a decrease in the content of leukocytes in the blood, and, in addition, they are hepatotoxic.

In general, the list is impressive, and ACE inhibitors have lost their title. However, in Russia they are still considered the first line of treatment for hypertension.

Let's look at them in more detail.

The first drug, the oldest of the entire group, captopril, known as CAPOTEIN.

It is recommended to take it before meals, as food inhibits its absorption. This is one of the fast-acting ACE inhibitors. Its effect develops when taken orally after 30 minutes - 1 hour, when taken sublingually - after 15-30 minutes. Therefore, the drug can be used as an emergency treatment for hypertensive crisis. It is important to remember that you can take no more than two tablets at a time, and no more than six per day.

The drug is contraindicated in pregnant, lactating, persons under 18 years of age, people with renal failure, narrowing of the lumen of both renal arteries.

Side effects include dry mucous membranes, dry cough, increased activity of liver transaminases, headache, dizziness, and there may be allergic reactions.

The second drug is the best-selling ACEIEnalapril, known under the names ENAP, ENAM, BERLIPRIL, RENITEK, etc.

The drug is a prodrug, that is, when taken orally, Enalapril maleate is converted in the liver into the active substance Enalaprilat. In addition to inhibiting ACE, it has a vasodilatory effect, improves renal blood flow, normalizes plasma cholesterol levels, and reduces the loss of potassium ions caused by diuretics.

Eating does not affect the absorption of the drug. It begins to act an hour after ingestion, the duration of action is from 12 to 24 hours, it depends on the dosage.

Contraindicated for persons under 18, pregnant and lactating women, and those with hypersensitivity to ACE inhibitors.

The next drug is lisinopril, or DIROTON.

Its main feature is that it is practically not metabolized in the liver, therefore, much less often than other ACE inhibitors, it causes dry mucous membranes and provokes a dry cough.

Another important advantage of the drug is that the part of it that is bound to ACE is excreted extremely slowly, which allows it to be used once a day. The drug reduces protein loss in urine.

Contraindicated for persons under 18, pregnant and lactating women.

Let's talk now about Perindopril, known as PRESTARIUM, PRESTARIUM A and PERINEVA.

Prestarium and Perineva are available in 4 and 8 mg doses, but Prestarium A is available in 5 and 10 mg doses. As it turned out, Prestarium A contains perindopril arginine, and Perinev and Prestarium contain perindopril erbumine. Comparing the features of pharmacokinetics, I realized this thing. In compounds containing perindopril erbumine, approximately 20% of the substance consumed becomes active, and in the perindopril compound, arginine becomes active - about 30%.

The second important feature is that perindopril has a long half-life, its effectiveness remains for 36 hours. And a lasting effect develops within 4-5 days. For comparison, lisinopril takes 2-3 weeks, enalapril takes a month.

The third feature of the drug is that it has an antiplatelet effect; its mechanism is complex and is associated with the formation of prostacyclin, a compound that reduces the ability of platelets to stick together and adhere to the vascular wall.

In light of this, the indications for use of the drug are wider. In addition to hypertension, it is indicated for chronic heart failure, stable coronary heart disease, to reduce the risk of cardiovascular disaster, and to prevent recurrent stroke in patients who have had cerebrovascular diseases.

The rest of the drugs in this group are similar to each other, only the onset of action and half-life differ. Therefore, I will not consider them separately.

And at the end of today's conversation, one very important warning:

All drugs in this group reduce potassium excretion, and additional intake of potassium-containing drugs such as Asparkam or Panangin without monitoring potassium levels in the blood can lead to hyperkalemia, which, in turn, can cause cardiac arrhythmias and, God forbid, cardiac arrest .

Write, don't be shy!

See you again on the blog for hard workers!

With love to you, Marina Kuznetsova