Canis ISSN: 2398-2942

ACE inhibitor: overview

Synonym(s): Angiotensin converting enzyme inhibitor

Contributor(s): Sonja Fonfara, Mark Rishniw

Actions of ACE

  • Angiotensin-converting enzyme (ACE) inhibitors inhibit ACE (present in the endothelia of the small blood vessels of the lungs, kidneys and other tissues).
  • ACE has vital roles in both the renin-angiotensin-aldosterone (RAA) system and kallikrein-kinin (bradykinin) system:
    • Renin is released from the juxtaglomerular apparatus in the kidney in response to:
      • Decreased renal blood flow.
      • Decreased sodium chloride delivery to the macula densa (sodium depletion, natriuresis).
      • Beta-adrenergic stimulation.
  • Renin converts angiotensinogen (made in the liver) into angiotensin I ( a precursor molecule which is mainly inactive).
  • ACE converts angiotensin I (a precursor molecule which is mainly inactive) to the active hormone angiotensin II.
  • ACE catalyses breakdown of bradykinin, a hormone that promotes vasodilation via nitric oxide and prostaglandins, and natriuresis in the kidney.

Actions of angiotensin II

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Effects of ACE inhibitors

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ACE inhibitors available

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ACE inhibitors and preclinical cardiac disease

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Clinical concerns for the use of ACE inhibitors

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Further Reading

Publications

Refereed papers

  • Recent references from VetMed Resource and PubMed.
  • OGrady M R, OSullivan M L, Minors S L et al (2009) Efficacy of Benazepril Hydrochloride to Delay the Progression of Occult Dilated Cardiomyopathy in Doberman Pinschers. J Vet Intern Med 23, 977-983 PubMed.
  • Atkins C E, Keene B W, Brown W A et al (2007) Results of the veterinary enalapril trial to prove reduction in onset of heart failure in dogs chronically treated with enalapril alone for compensated, naturally occurring mitral valve insufficiency. J Am Vet Med Assoc 231(7), 1061-1069 PubMed.
  • Besche B, Chetboul V, Lachaud Lefay M P et al(2007) Clinical evaluation of imidapril in congestive heart failure in dogs: results of the EFFIC study. J Small Anim Pract 48(5), 265-270 PubMed.
  • Lefebvre H P, Jeunesse E, Laroute V et al(2006) Pharmacokinetic and pharmacodynamic parameters of ramipril and ramiprilat in healthy dogs and dogs with reduced glomerular filtration rate. J Vet Intern Med 20(3), 499-507 PubMed.
  • Amberger C, Chetboul V, Bomassi E et al(2004) Comparison of the effects of imidapril and enalapril in a prospective, multicentric, randomized trial in dogs with naturally acquired heart failure. J Vet Cardiol 6(2), 9-16.
  • The BENCH (BENazepril in Canine Heart disease) Study Group (2004) Long-term tolerability of benazepril in dogs with congestive heart failure. J Vet Cardiol 6(1), 7-13.
  • Toutain PL & Lefebvre (2004) Pharmacokinetics and pharmacokinetic/pharmacodynamic relationships for angiotensin-converting enzyme inhibitors. J Vet Pharmacol Therap 27, 515-525.
  • Atkins C E, Brown W A, Coats J R et al(2002) Effects of long-term administration of enalapril on clinical indicators of renal function in dogs with compensated mitral regurgitation. J Am Vet Med Assoc 221(5), 654-658.
  • Kvart C, Haggstrom J, Pedersen H D et al(2002) Efficacy of enalapril for prevention of congestive heart failure in dogs with myxomatous valve disease and asymptomatic mitral regurgitation. J Vet Intern Med 16(1), 80-88PubMed.
  • The BENCH (BENazepril in Canine Heart disease) Study Group (1999) The effect of benazepril on survival times and clinical signs of dogs with congestive heart failure: Results of a multicenter, prospective, randomized, double-blinded, placebo-controlled, long-term clinical trial. J Vet Cardiol 1(1), 7-18.
  • Davidson G (1999) Enalapril Maleate. Comp Contin Educ Pract Vet 21(12), 1118-1121.
  • Lefebvre H P, Laroute V, Concordet D et al(1999) Effects of renal impairment on the disposition of orally administered enalapril, benazepril, and their active metabolites. J Vet Intern Med 13(1), 21-17 PubMed.
  • Ettinger S J, Benitz A M, Ericsson G F et al(1998) Effects of enalapril malaete on survival of dogs with naturally acquired heart failure. J Am Vet Med Assoc 213(11), 1573-1577.
  • Hamlin R L & Nakayama T (1998) Comparison of some pharmacokinetic parameters of 5 angiotensin-converting enzyme inhibitors in normal beagles. J Vet Intern Med 12(2), 93-95.
  • Boswood A (1998) Rationale for the use of drugs in the treatment of cardiovascular disease. 2. Vasodilators. In Practice 20, 55-63.
  • King J N, Maurer M, Morrison C A et al(1997) Pharmacokinetics of the angiotensin-converting-enzyme inhibitor, benazepril, and its active metabolite, benazeprilat, in dogs. Xenobiotica 27(8), 819-829.
  • Boswood A (1996) Rationale for the use of drugs in the treatment of cardiovascular disease. 1. Diuretics. In Practice 18, 469-476.
  • The IMPROVE Study Group (1995) Acute and short-term hemodynamic, echocardiographic, and clinical effects of enalapril maleate in dogs with naturally acquired heart failure: Results of the Invasive Multicenter PROspective Veterinary Evaluation of Enalapril Study. J Vet Intern Med 9(4), 234-242.

Other sources of information

  • Opie L H, Poole-Wilson P A, Pfeffer M A (2005) Angiotensin-Converting Enzyme (ACE) Inhibitors, Angiotenin-II Receptor Blockers (ARBs), and Aldosterone Antagonists. In: Drugs for the Heart, 6th ed., Eds: L. H. Opie & B, J, Gersh. Elsevier Saunders, Philadelphia.
  • Lombard C (2000) 10th ESVIM Congress, Neuchatel.


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