Mechanism of blood pressure control with ACE inhibitors-by Dr Harold Gunatillake
Website:www.Doctorharold.com
Transcript: Your body has a system to keep your blood vessels narrowed, increase salt retention and water- to maintain the blood pressure in case of emergency situations such as traumatic bleeding, and at other times.
This system is called the Renin-Angiotensin-Aldosterone System or RAAS.
When the blood pressure increases with age due to over-reaction of this system, there are counter-acting drugs to minimize this situation.
We are discussing today about Angiotensin converting enzyme inhibitors, or ACE inhibitor drugs used to maintain a normal range blood pressure.
You may be taking Angiotensin converting enzyme inhibitors (ACE inhibitors) or Angiotensin receptor blockers (ARB) for high blood pressure prescribed by your doctor.
These drugs are differentially used in elderly patients with hypertension.
High blood pressure should not be ignored in elderly people, because it is associated with cerebrovascular. Cardiovascular, renal issues and mortality.
Blood pressure must be reduced according to the needs of the patients based on age, race, severity of hypertension, co-existing medical problems.
Co-existing medical conditions (such as asthma, diabetes mellitus, heart failure, renal failure, gout, coronary artery disease, hyperlipidemia, and peripheral vascular disease) are major determinants for the selection of antihypertensive medications
Angiotensin converting enzyme (ACE) inhibitors are not only efficacious antihypertensive agents in the elderly, but also appear promising in counteracting some of the cardiovascular and renal consequences of hypertension. They are well tolerated and have a low incidence of adverse effects. ACE inhibitors possess ancillary characteristics that are potentially beneficial for many elderly patients, including reduction of left ventricular mass, lack of metabolic and lipid disturbances, no adverse CNS effects, no risk of induction of heart failure, and a minimal risk of orthostatic hypotension.
So, that would be the first line of drugs doctors will prescribe for older people.
Since ACE inhibitors may improve perfusion to the heart, kidney, and brain, they are well worth considering for the treatment of elderly patients with hypertensive target organ damage, especially in patients with heart failure, and diabetic patients with early nephropathy.
What is Angiotensin-1?
Let us talk about Angiotensin first and proceed to drugs that blocks it later in the discussion to reduce your high blood pressure.
Angiotensin is a peptide hormone that causes narrowing or vasoconstriction of arteries, causing increased blood pressure. It is part of the renin-angiotensin system, which regulate blood pressure.
Now what is renin-angiotensin system or the RAS, as it is called.
It is also called renin-angiotensin-aldosterone system or RAAS. This system is a critical regulator of blood pressure, including blood volume and electrolyte balance.
Normally renin secreted by special cells in the kidneys if blood pressure is too low thus activating angiotensin 11 to increase blood pressure and vascular resistance.
Angiotensin 11 derived from Angiotensin 1 by an enzyme secreted in the walls of blood vessels called angiotensin converting enzymes.
When your blood pressure drops too low or your body does not have enough salt, renin gets sent into your blood stream. That triggers a chain reaction that creates a hormone called angiotensin and signals your adrenal glands to release another hormone called aldosterone.
Angiotensin also stimulates the release of aldosterone from the adrenal gland that sits on each kidney like a cap, promoting retention of sodium by the kidneys.
In short angiotensin by narrowing arteries and retention of salt helps maintain normal range blood pressure and fluid balance in the body.
This is a natural event when people are traumatized to minimize the rate of bleeding for survival.
The precursor of angiotensin is a protein called angiotensinogen produced in the liver.
Angiotensinogen broken up by renin, an enzyme produced in the kidneys to form angiotensin 1. As the blood passes through the lungs and kidneys, further metabolized to produce angiotensin 11 by the angiotensin-converting enzyme.
Angiotensin- converting enzyme is produced by the vascular endothelium or inner lining cells to help regulate blood pressure.
Its catalysis- meaning accelerating the conversion of angiotensin 1 an inactive protein to angiotensin 11.
So, lets summarize what we have learnt so far.
Liver produces angiotensinogen
This is broken down to Angiotensin 1 by hormone renin secreted in the kidneys.
Now the angiotensin converting hormones secreted in the inner lining of arteries converts angiotensin 1 into angiotensin 11.
Angiotensin 11 raises blood pressure by several actions, the most important ones being vasoconstriction or narrowing of blood vessels.
Now let us talk about angiotensin converting enzyme inhibitors. These are drugs that cause dilation or relaxing of blood vessels by inhibiting the production of angiotensin 11.
These are drugs used to treat high blood pressure, heart problems and other conditions.
The major organs that ACE inhibitors affects are the kidneys, blood vessels, heart brain and adrenal glands.
As I said earlier ACE inhibitors or angiotensin converting enzyme inhibitors work by primarily relaxing the blood vessels, on the other hand angiotensin formed by breaking down of angiotensinogen produced in the liver cause narrowing or vasoconstriction of blood vessels.
So, ACE inhibitors are used to in the treatment of high blood pressure.
Those ACE inhibitors come in various labels, such as, capoten, Monopril, enalaprilat, Zestril, Lotensin, Accupril, lisinopril and so on, and your doctor would have prescribed one of those drugs which you take for high blood pressure.
ACE inhibitors act by stopping the action of an enzyme called angiotensin- converting enzymes described earlier as produced by the inner lining of blood vessels.
Angiotensin- converting enzyme signals protein in the body, converting angiotensin 1 to angiotensin 11. Angiotensin 11 narrows blood vessels and contributes to salt and water retention in the body which increases the blood pressure as mentioned earlier.
ACE inhibitors has side affects you should be aware of if your doctor has prescribed for you for high blood pressure.
They are a dry cough, low blood pressure, fatigue, dizziness, headache, loss of taste and skin rashes.
If you get any of these side effects, remember they may be due to your ACE inhibitors.
There are more serious side effects too:
Swelling of the area beneath the skin.
Increased potassium levels in the blood
Renal failure if you have narrowing of renal arteries
They may be harmful to both mother and the baby if taken during pregnancy.
And lastly chest pain and pancreas gland swelling.
Please see your doctor if you get any of these serious side effects.
Hope this video article was useful.
Wear your mask and keep your social distances in crowds, even though you have had both vaxxes.
Goodbye for now.
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