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- Title
The potential role of angiotensin-converting enzyme inhibition in peripheral arterial disease.
- Authors
Hirsch, Alan T.; Duprez, Daniel
- Abstract
Peripheral arterial disease (PAD) is associated with significant morbidity and mortality, and yet remains under-recognized and under-treated. Atherosclerosis is the most common cause of lower extremity PAD and pharmacological interventions that alter this central patho- genic role of atherosclerosis may alter the natural history of PAD. There is growing evidence that the renin-angiotensin system (RAS) is a signi cant mediator of this disease process and that treatment with angiotensin-converting enzyme (ACE) inhibitors is associated with vasculopro- tective effects that are independent of the antihypertensive properties of these agents. Numerous lines of evidence suggest that ACE inhibitors directly inhibit the atherosclerotic process and improve vascular endothelial function. In patients with PAD, ACE inhibitors have been shown to improve peripheral circulation as measured by peripheral arterial blood pressure and by increases in peripheral blood flow. Preliminary evidence suggests that ACE inhibitors might improve clinical symptoms in patients with PAD. Recent evidence has confirmed that ACE inhibition is associated with a decrease in morbidity and mortality in patients with arterial disease without left ventricular dysfunction; this benefit was at least as great for the subset of patients with PAD. Overall, these data support a significant role for the RAS in the pathogenesis of all atherosclerotic diseases (including PAD) and suggest that the benefit is independent of the blood pressure lowering properties of these agents. These studies suggest that ACE inhibitor therapy should be considered in the routine management of individuals with PAD, regardless of whether they have hypertension or left ventricular dysfunction.
- Subjects
VASCULAR diseases; ANGIOTENSINS; ATHEROSCLEROSIS; ARTERIAL stenosis; VASCULAR endothelium; HYPERTENSION; MORTALITY
- Publication
Vascular Medicine, 2003, Vol 8, Issue 4, p273
- ISSN
1358-863X
- Publication type
Article
- DOI
10.1191/1358863x03vm502oa