ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS AND VASCULAR REMODELING IN HYPERTENSION

The prescription of angiotensin converting enzyme (ACE) inhibitors con tributes in everyday practice to the normalisation of blood pressure ( BP) in individuals with essential hypertension (HT). Inhibition of the circulating renin angiotensin system (RAS) is accompanied, acutely, b y a fall in BP. The effects of ACE inhibitors in the longer term is mo re complicated, including inhibition of tissue RAS and, finally, an ac tion on the vascular structure itself which is apparently of fundament al importance. ACE inhibitors contribute to improving compliance of ma jor arteries and to decreasing arteriolar resistance while leaving reg ional blood flow unaffected. There are additional beneficial modes of action such as the reversibility of endothelial dysfunction or inhibit ion of the cell migrations which are a prelude to atherosclerosis. The se effects may be linked to the therapeutic group, but certain ACE inh ibitors with particular tissue tropism have a more effective action re garding tissue RAS. This might be associated with a more significant f all in HT-related cardiovascular morbidity.