The Role of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Postangioplasty Restenosis

Postangioplasty restenosis remains a clinical problem, and various strategies have been used to minimize or eliminate this complication. Stimulation of the renin-angiotensin system has been shown to cause vascular smooth muscle migration, matrix deposition, and endothelial dysfunction, which are possible causes of postangioplasty restenosis, suggesting that the use of angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin receptor blockers might ameliorate or prevent restenosis. However, data obtained to date in both animal and human studies of various designs show conflicting results regarding the benefit or lack of benefit of angiotensin inhibition strategies. It has also been shown that the type of ACE genotype may influence the effects of drugs on restenosis, suggesting that in the future, a pharmacogenetic approach might be of use for augmenting the benefit in patients from inhibitors of the angiotensin system. As of now, there are no supportive data to suggest a benefit of using routine ACE inhibitors or angiotensin receptor blockers to prevent postangioplasty restenosis in the general population.