Thursday, May 31, 2007

ACE inhibitors

We've got a lot of drug choices availble to lower high blood pressure. Some older drugs that effectively lowered pressure have fallen by the wayside because, while they enable patients to reach a satisfying 'numbers' goal, that success did not translate out into a decrease in risk of future heart attack or stroke which is really the point of treating hypertension.

The ACE inhibitors are a class of blood pressure meds that remain on the "A" list. These drugs work by inhibiting a cascade of events initiated by the kidneys that result in the constriction of blood vessels. When blood vessels narrow, the same amount of fluid (your blood volume) is now in a smaller space, and pressure rises. These angiotensin converting enzyme inhibitors partially block the conversion of an inactive substance produced by the liver--angiotensinogen--to an active vasoconstricting molecule called angiotensin.

Not only do ACE inhibitors lower pressure and thus lower risk of heart attack and stroke, they also promote normal blood vessel behavior independent of their effect on blood pressure. Furthermore, new evidence suggests that several drugs in this category help peope hold onto their marbles through the years.

Several ACE inhibitors cross the 'blood-brain barrier,' the tight junction between the blood and all the good and bad things coursing through it and the delicate nerve cells in the noggin. Persons of age taking these drugs, including captopril, lisinopril, ramipril, and fosinopril, were followed over six years time for the development of dementia as a function of their blood pressure medication choice during the Cardiovascular Health Study.

Those oldsters on brain active ACEIs were 50% less likely to demonstrate a decline in mental functioning during the study. The lead investigator concluded, "If an ACE-inhibitor is indicated, I would recommend using one that crosses the blood-brain barrier."

At a time in our lives when we are intent on getting all parts to the finish line, going for the 'three-for-one' action of these drugs seems like a great strategy.

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