Fibrinolytic actions of ACE inhibitors: a significant plus beyond antihypertensive therapeutic effects
Authors: L Dézsi
Journal: Cardiovascular Research (2000)

See article by Labinjoh et al. [14] ( pages 707 -714) inaccumulation of different cells takes place in the subenthis issue.dothelial space, and there is an adherence of blood-borne cells to the endothelial surface.A very serious conse-Hypertension is one of the most common diseases, quence of these changes in cerebral vessels is an increased shown by the fact that about 35% of adult males in the incidence of both hemorrhagic and ischemic strokes [3].In Western World suffer from it.The incidence is getting addition, hypertension affects the heart causing left venhigher with age, since over 65 years of age more than half tricular hypertrophy and structural changes in the myocarof the population has high blood pressure.The situation is dium.Elevated vascular resistance represents an increased similar or even less favorable in Middle and Eastern afterload.These changes may lead to decreased contractili-European Countries.Untreated hypertension poses an ty, and an overall decrease in left ventricular performance acute life threatening condition.For more than 100 years, [4].several attempts have been made to classify forms of In multi-center clinical trials conducted in the 1980s hypertension by etiology and severity, and introduce monitoring the effects of antihypertensive therapy favorantihypertensive therapy [1].Thanks to very intense basic able effects such as reduction of major cardiac and stroke and clinical research on this field, several types of anti-complications were observed, however, difficulties also hypertensive drugs have been developed with different emerged.For example, it was a great disappointment that mechanisms of action.Currently diuretics (e.g.thiazides), in the Australian Mild Hypertension Study and The beta-receptor antagonists, calcium channel blockers, alpha-Multiple Risk Factor Intervention Trial aggressive thiazide receptor antagonists, and angiotensin-converting enzyme diuretic, or beta adrenergic blocker therapy resulted in (ACE) inhibitors are commonly used for the management adverse effects such as greater mortality, hyperglycemia, of hypertension.Some other drugs (vasodilators, drugs that or increased triglyceride and VLDL levels [3].act on central and peripheral sympathetic nervous system) ACE inhibitors acting on the renin-angiotensin system are less frequently used [2].represent a powerful tool to reduce blood pressure.Major Hypertension is dangerous not only per se, but also advantages of ACE inhibitor therapy are few side effects, because it is one of the most severe cardiovascular risk no metabolic effects, and no water retention in the course factors in man.Hypertension may elicit changes in the of treatment.It has been established that ACE inhibitors arterial wall, causing a reduction in internal diameter and not merely control hypertension, but they can prevent elasticity of vessels subsequent to intimal and medial further cardiovascular events.A number of large scale thickening, smooth muscle cell hypertrophy, and deposi-trials including Cooperative North Scandinavian Enalapril tion of collagen.Hypertension can contribute to the Survival Study (CONSENSUS), Veteran's Administration acceleration of atherosclerosis if concomitant hyperlipo-Cooperative Vasodilator Heart Failure Trial (V-HeFT), proteinemia is present, and it can also lead to functional Studies of Left Ventricular Dysfunction (SOLVD), and changes in endothelial permeability, but not to complete Survival and Ventricular Enlargement (SAVE) trial have denudation.Under hypertensive conditions a significant shown that ACE inhibitors can reduce mortality of heart failure.They also reduced left ventricular preload and afterload.Enalapril was found to have beneficial effects in