This editorial highlights an alternate pathway for Angiotensin II generation via increased chymase activity in cardiac interstitial fluid during chronic ACE inhibition, explaining the return of Angiotensin II levels to normal.
Ang II plays an important role in the pathophysiology of cardiovascular disease. Angiotensin-converting enzyme (ACE) inhibitors lower Ang II levels by inhibiting conversion of Ang I to Ang II, but Ang II levels have been shown to return to normal with chronic ACE inhibitor treatment. In this issue of the JCI, Wei et al. show that ACE inhibition induces an increase in chymase activity in cardiac interstitial fluid, providing an alternate pathway for Ang II generation.
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Zablocki et al. (2010) studied this question.
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