ACE-Hemmer und arterielle Gefäßwand

Zusammenfassung

Angiotensin-Converting-Enzyme-(ACE-)Inhibitoren können über ihre blutdrucksenkende Wirkung hinaus vasoprotektiv sein. Dabei gibt es sowohl Ergebnisse aus experimentellen Studien als auch eine zunehmende Anzahl klinischer Daten, die zeigen, daß ACE-Inhibitoren einen antiatherogenen Effekt haben. Es gibt Hinweise, daß ACE-Inhibitoren auch den Einfluß von vaskulären Risikofaktoren wie dem oxidativen Streß abschwächen können. Weiterhin konnte gezeigt werden, daß die inflammatorische Reaktion der Gefäßwand günstig beeinflußt werden kann. Arbeiten der jüngsten Zeit weisen darauf hin, daß vor allem Risikogruppen von der Gabe eines ACE-Hemmers hinsichtlich vaskulärer Morbidität und Mortalität profitieren. Obwohl die Mehrzahl der Studien bislang auf die koronare Herzkrankheit beschränkt war, gibt es Hinweise, daß die Atherosklerose auch an nichtkoronaren Gefäßen durch eine ACE-Hemmung günstig beeinflußt wird. Zum gegenwärtigen Zeitpunkt sind jedoch trotz der Vielzahl an Daten weitere Untersuchungen zum Mechanismus der vaskulären Wirkung von ACE-Hemmern notwendig, bevor eine abschließende Beurteilung ihrer Bedeutung bei der Behandlung der Arteriosklerose erfolgen kann.

Summary

In addition to their hypotensive action, angiotensin converting enzyme (ACE) inhibitors can also have vasoprotective effects. Results from experimental studies as well as a growing body of data show that ACE inhibitors have an antiatherogenic effect. There are also indications that ACE inhibitors may weaken vascular risk factors such as oxidative stress. Furthermore, it has also been shown that they can have a positive influence on inflammatory reactions in the vessel wall.

The most recent studies indicate that risk groups benefit most from taking an ACE inhibitor in terms of vascular morbidity and mortality. Although the majority of studies to date have been restricted to coronary heart disease, there are signs that atherosclerosis in non-coronary vessels is also positively influenced by ACE inhibition. At present, however, and despite the large body of data, further studies of the mechanism of the vascular action of ACE inhibitors are needed before a firm conclusion can be drawn on their impact in the treatment of arteriosclerosis.

Schlüsselwörter

Angiotensin II - Atherogenese

Keywords

Angiotensin II - atherogenesis

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