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Hypertensive Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
On the basis of limited trial data, labetalol and nifedipine are the current antihypertensive drugs most used by experts. Labetalol dosing can start at 100 mg twice a day, with a maximum dose of 2400 mg a day. Nifedipine is started at 10 mg twice a day, or 30 mg XL once a day, with a maximum dose of 120 mg/day. Angiotensin-converting enzyme (ACE) inhibitors are contraindicated in pregnancy.
Antioxidant Effects of Peptides
Published in Mesut Karahan, Synthetic Peptide Vaccine Models, 2021
Rümeysa Rabia Kocatürk, Fatmanur Zehra Zelka, Öznur Özge Özcan, Fadime Canbolat
Hypertension is a cardiovascular disease that affects approximately one quarter of the world’s population and is a controllable risk factor that plays a role in related complications. The angiotensin I-converting enzyme (ACE) is a dipeptityl carboxypeptitase and has the role of turning angiotensin I to angiotensin II. Angiotensin II has a general vasoconstriction impact. It plays an important physiological role in controlling blood pressure, liquid, and salt balance in vertebrates (Hartmann and Meisel 2007; Hayes et al. 2016) and peptides that repress the ACE enzyme are potentially assumed as agents that lower the blood pressure (Kannan, Hettiarachchy, and Marshall 2012). Therefore, a great deal of research has been carried out on the peptide production which shows antihypertensive activity from milk, cheese, meat, fish, and a wide variety of plants and algae. However, no correlation has been reported between in vivo antihypertensive effects and the results of in vitro studies investigating the inhibition of ACE enzymes. In this manner, there is no assurance that the result that is taken from ACE inhibition acquired in vitro will have a similar impact in vivo (Majumder and Wu 2013; Miralles, Amigo, and Recio 2018; Ünal, Şener, and Cemek 2018; Girija 2018).
Drugs in pregnancy and lactation
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Angiotensin converting enzyme (ACE) is a dipeptyl carboxypeptidase that releases the pressor peptide angiotensin II (ANG II) from angiotensin I and inactivates bradykinin as well [28]. ACE is present in both vascular and extra-vascular tissues (brush border) of the kidney. While the extravascular localisation of ACE is not fully known, this enzyme is found on glomerular endothelial cells at the place where the capillary invades the inferior cleft of the S-shaped body. ACE may participate in the tubular handling process of ANG II, as it has been found on the apical and basolateral membranes already in the early nephron stage. This glomerular distribution in the fetal kidney looks different as compared to the more mature kidney where ACE is essentially found in the peritubular endothelial cells. The switch of ACE from glomerular to peritubular vessel with maturation has been well documented and occurs progressively during infancy. In addition to the renal haemodynamic regulation, the ANG II locally generated in the glomerulus also stimulates angiogenesis through the stimulation of its receptors.
Understanding the role of chronopharmacology for drug optimization: what do we know?
Published in Expert Review of Clinical Pharmacology, 2023
Akio Fujimura, Kentaro Ushijima
Angiotensin-converting enzyme (ACE) inhibitors have characteristic adverse effects, including troublesome dry cough, which is mediated via the action of bradykinin and a common reason for cessation of treatment with these agents. In one study, enalapril, an ACE inhibitor, was administered orally to 12 hypertensive patients at 10:00 or 22:00 in a crossover manner, and dry cough was detected in two patients after dosing at 10:00 but not after dosing at 22:00 [67]. Considering that the plasma bradykinin concentration was elevated only in patients in that study who complained of dry cough, it was anticipated that a change in dosing time from morning to evening would ameliorate dry cough in patients on ACE inhibitor therapy. Subsequent study supported the idea [68]. Twenty-one patients with hypertension and three patients with congestive heart failure were participated in this study. They received enalapril (an ACE inhibitor) once daily in the morning and complained of dry cough. After changing a dosing-time from morning to evening, the frequency of dry cough was changed as follows: disappeared − 4 patients, ameliorated − 16 patients, unchanged − 4 patients, elevated – non). The rate of continuation of ACE inhibitor therapy is relatively low at 45% after 6 months of treatment [69] and might be improved by application of chronotherapy.
Establishing target systolic and diastolic blood pressure in diabetic patients with hypertension: what do we need to consider?
Published in Expert Review of Cardiovascular Therapy, 2021
While beyond the remit of this review, it is worth briefly discussing the role of CKD in the setting of BP targets for patients with T2DM. CKD is well recognized as a significant risk factor for CVD [33] which bears relevance to diabetes mellitus as diabetic nephropathy is a leading cause of CKD [34]. While standard pharmacological treatment of hypertension with angiotensin converting enzyme inhibitors is also renoprotective [35], the recognition and prescription of such medications are often low [36]. The presence of CKD has been shown in trials such as SPRINT [13] and the Irbesartan Diabetic Nephropathy Trial (IDNT) [37] to lower the likelihood of reaching BP targets as compared to the general hypertensive population [38], which suggests that adults with CKD require more intensive BP regimens. Furthermore, a sub-group analysis of participants with CKD in the SPRINT dataset suggested that intensive BP targets reduced CVD outcomes, albeit the evidence for benefit on renal outcomes remains mixed [39].
Assessment of angiotensin converting enzyme gene polymorphism in preeclampsia mothers of Bangladesh
Published in Journal of Obstetrics and Gynaecology, 2021
Md. Bayejid Hosen, Md. Mostafijur Rahman, M. Zakir Hossain Howlader, Yearul Kabir
During normal pregnancy, the renin–angiotensin–aldosterone system (RAAS) augments the plasma levels of renin and aldosterone (Kaur et al. 2005). On the other hand, preeclamptic mothers suffer from suppression of the RAAS system and become highly sensitive to the pressor effects of angiotensin II together with increased vascular resistance during pregnancy (Kim et al. 2004). Angiotensin-converting enzyme (ACE) is an vital circulating enzyme of the RAAS system which catalyses the conversion of angiotensin I to angiotensin II and also degrades bradykinin (Rigat et al. 1990). Thus, ACE plays an important role in blood pressure homeostasis and may influence the occurrence of preeclampsia (Kim et al. 2004). Though different studies provided contradictory results about ACE level during preeclampsia, it was previously reported that a common I/D polymorphism in intron 16 of the ACE gene is said to be linked with different plasma ACE levels, and individuals who are bearing the D allele had higher ACE activities (Rigat et al. 1990). Besides, several studies have indicated that pregnant mothers had higher ACE activity who are carrying the D allele (Mello et al. 2003). A significant association between the D allele and the occurrence of preeclampsia has been shown by Salimi et al. (2011) in Iranian women. The association of D allele with the onset of early preeclampsia has also been reported in Egyptian mothers by Kamha et al. (2013).