Effect of high- versus low-dose angiotensin converting enzyme inhibition on cytokine levels in chronic heart failure

Abstract

In patients with severe CHF, high-dose enalapril therapy is associated with a significant decrease in IL-6 activity. However, despite treatment with a high-dose ACE inhibitor, a persistent immune activation exists in these patients which may be of importance for the progression of CHF.

Inflammatory Biomarkers in Heart Failure

“…25 High doses of angiotensin-converting enzyme inhibitors appear to favorably affect inflammatory cytokines, with high doses (40 mg/d) of enalapril leading to decreases in circulating IL-6, whereas lower doses (5 mg/d) did not. 26 The 3-hydroxy-3-methylglutarylcoenzyme A reductase inhibitors or statins have anti-inflammatory effects, and recent data suggest they may have clinically relevant anti-inflammatory effects in HF. Small preliminary studies with both simvastatin and atorvastatin in patients with idiopathic cardiomyopathy have demonstrated improvement in both inflammatory markers and ejection fraction compared with placebo 27,28 (Figure 3).…”

Effects of ramipril in nondiabetic nephropathy: improved parameters of oxidatives stress and potential modulation of advanced glycation end products

“…Interestingly, activation of monocytes/macrophages (as indicated by elevated neopterin, TNF-a and IL-1b levels) in heart failure was also uninfluenced by ACEI, even after administration of a high-dose regimen, reflecting a persistent immune activation by mechanisms other than AT II. 37 Taken together, first evidence is herewith given that administration of the ACEI ramipril to patients with nondiabetic nephropathies results in a slight but significant decline of fluorescent AGE levels, while the CML concentration remains unchanged. These effects of ramipril are accompanied by an amelioration of AOPPs and lipid peroxidation.…”

Novel targets and new potential: developments in the treatment of inflammation in chronic kidney disease

“…In one study of patients with CHF high dose enalapril reduced IL-6 levels, with a concomitant decrease in the thickness of the interventricular septum. [114] In another short term study of CHF patients the use of candesartan reduced plasma levels of TNF-alfa, IL-6 and vascular adhesion molecules. [115] ACE inhibitors have also shown anti-inflammatory properties in the general population and in patients with CKD.…”