ACE inhibitors first appeared in America in the 80s of the last century, it was then that the first representative of the ACE inhibitor group, captopril, was synthesized. An analogue of substances from this group was found in the venom of snakes that live in a number of Asian countries; later, various analogues of this substance were synthesized, each of which has two leading effects - antihypertensive and organoprotective, which served as the basis for wide distribution and contributed to the continuous expansion of indications to use an ACE inhibitor.
To date, more than 13 active substances are known that belong to ACE inhibitors. A wide range of clinical randomized placebo-controlled trials were conducted for this group of drugs, which proved their high efficiency for correcting arterial hypertension and achieving target blood pressure values, as well as organ protective agents for all forms of coronary heart disease, kidney damage, diabetes mellitus and even for the prevention of strokes .
ACE inhibitors in clinical practice
ACE inhibitors are not prescribed as a preventive treatment, however, the spectrum of their use is so wide that almost all cardiological patients should receive a drug from this group, and patients with pathology of internal organs need ACE inhibitors in more than half of cases, especially given the increasing incidence of sugar type 2 diabetes.
It is worth noting that angiotensin-converting enzyme inhibitors not only do not lose their significance, but also become more and more popular, despite the fact that their analogues have appeared, which have a number of advantages. In particular, we are talking about sartans (antagonists of receptors for angiotensin 2). The latter do not block the kallikrein-kinin system and do not cause the development of cough, however, they are deprived of such pronounced organoprotective properties as ACE inhibitors possess. Therefore, the appointment of sartans can be considered a more appropriate choice only in patients with isolated arterial hypertension, without coronary heart disease, heart failure, diabetes mellitus and kidney pathology.
Prospects for the use of ACE inhibitors
Inhibitors of the angiotensin-converting enzyme, regardless of the time of starting their intake and subject to the proper intake and dosage regimen, show excellent results in terms of improving the prognosis, reducing the risk of complications of the underlying disease for which they are being taken, and also increase the quality and life expectancy.
The development of new ACE inhibitors that have certain pharmacokinetic advantages, in particular, dual metabolic pathways and a prolonged effect, significantly expands the possibilities of their use, primarily by increasing compliance and the possibility of use in the presence of a combined pathology. In addition, the appointment of angiotensin converting enzyme inhibitors, given the mechanism of action of ACE inhibitors and the characteristics of individual drugs, allows you to achieve the desired effect in each patient, depending on the stage of the disease, the presence of concomitant pathology and other individual characteristics.