What question did this study set out to answer?

To compare the pharmacodynamic actions and blood pressure responses across angiotensin-converting enzyme inhibitors, renin inhibitors, and angiotensin II receptor antagonists.

December 1, 1992Journal of Hypertension

Renin inhibitors, angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists

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Why the study?

How do ACE inhibitors, renin inhibitors, and Ang II antagonists compare in their effects on blood pressure and plasma Ang II levels in hypertensive subjects?

Population

Hypertensive subjects

Design

Review

Authors

MSMaarten A.D.H. SchalekampGeneral / Preventive / Lipids FDF. H. M. DerkxGeneral / Preventive / Lipids AMAnton H. van den MeirackerVascular Medicine

Discussion

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Implication

Supports common BP-lowering mechanism via effective Ang II reduction across RAS inhibitors; leaves open prospective validation of assay methods and time-courses.

Key Points

To compare the pharmacodynamic actions and blood pressure responses across angiotensin-converting enzyme inhibitors, renin inhibitors, and angiotensin II receptor antagonists.
Surveyed published pharmacological data and clinical assays measuring the renin-angiotensin system during treatment with three drug classes.
Assessed 24-hour blood pressure curves in relation to plasma angiotensin I and II levels and identified ex vivo measurement errors.
Apparent returns of normal plasma angiotensin II during long-term ACE inhibition were attributed to assay artefacts from ex vivo peptide formation rather than true in vivo failure.
Blood pressure lowering correlated with decreases in effective receptor-bound angiotensin II across all three drug classes, though renin inhibitors displayed a delayed peak pressure reduction relative to peptide suppression.
Routine plasma renin activity assays overestimated in vivo inhibition because assay protease inhibitors displaced protein-bound renin inhibitors ex vivo.

Structured PICO

How do ACE inhibitors, renin inhibitors, and Ang II antagonists compare in their effects on blood pressure and plasma Ang II levels in hypertensive subjects?

Population

Hypertensive subjects

Intervention

Angiotensin converting enzyme (ACE) inhibitors, renin inhibitors, and angiotensin II (Ang II) antagonists

Outcome

Blood pressure reduction and plasma Ang II levelssurrogate

Accurate measurement of in vivo renin and Ang II levels is necessary to properly compare the blood pressure-lowering mechanisms and time-courses of ACE inhibitors, renin inhibitors, and Ang II antagonists.

Limitations

Difficulties in measuring low Ang II levels in the presence of high Ang I levels
Routine assays of renin activity can overestimate in vivo inhibition during renin inhibitor treatment

Cite This Study

Schalekamp et al. (1992) studied this question.

synapsesocial.com/papers/6a70ca06a528af2d65c3bd95 https://doi.org/10.1097/00004872-199212000-00017

Topics

Hypertension management

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Implication

Supports common BP-lowering mechanism via effective Ang II reduction across RAS inhibitors; leaves open prospective validation of assay methods and time-courses.

Renin inhibitors, angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Renin inhibitors, angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

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Topics

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