Pharmacological, Immunological, and Gene Targeting of the Renin-Angiotensin System for Treatment of Cardiovascular Disease

Abstract

Effective blood pressure control with a large arsenal of conventional antihypertensive drugs, such as diuretics, beta-adrenergic blockers, and calcium channel blockers, significantly reduce the morbidity and mortality associated with cardiovascular disease. However, blood pressure control with these drugs does not reduce cardiovascular disease risks to the levels in normotensive persons. Only two drug classes that inhibit or antagonize portions of the renin-angiotensin system (RAS), angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor type-1 (AT(1) receptor) blockers, have protective and beneficial effects unrelated to the degree of blood pressure reduction. These drugs may prevent the blood pressure related functional and structural abnormalities of the cardiovascular system and reduce the end organ-damage. The first part of this review presents the components of the RAS, biological actions of angiotensin peptides, and the functions of the enzymes that generate and metabolize angiotensins, including the likely effect of manipulating them. Special attention is devoted to renin, ACE, ACE2, chymase, and neprilysin. The second part of this review presents the rationale for targeting the RAS, based on clinical studies of the ACE inhibitors and AT(1) receptor blockers. Finally, we present the investigational agents acting on the RAS that have a potential for clinical usage, and give the perspective of pharmacological, immunological and gene targeting of the RAS for treatment of cardiovascular disease.

Hypertension, medications, and risk of severe COVID‐19: A Massachusetts community‐based observational study

“…Calcium channel blockers do not increase expression of ACE2, and thiazide may decrease expression 16 so they were also good comparators. 35 Our findings that these drugs do not increase or decrease severity risk are consistent with other newly published studies which also address the research gaps of evaluation of non-hospitalized COVID-19 patients. 12,13,26,36 Our findings do not support the discontinuation level, 37 anticoagulant medication use, 38 diabetes control, 39 blood type, 40 MMR, and flu vaccine status, 41 in both the general and younger populations, is warranted.…”

Characterization, Preparation, and Purification of Marine Bioactive Peptides

“…ACE can catalyse the conversion of angiotensin I to angiotensin II, and angiotensin II is a potent vasoconstrictor that increases peripheral vascular resistance and consequently elevates arterial pressure [56, 57]. Therefore, in the development of drugs to control high blood pressure, ACE inhibitors and angiotensin receptor blockers are now used clinically for the treatment of various cardiovascular diseases [58]. However, the synthetic drugs such as captopril, lisinopril, and enalapril [59] are believed to have certain side effects such as a cough, skin rash, loss of taste, or angioneurotic oedema [60, 61].…”

Editorial [Hot Topic: Applications of Angiotensin Converting Enzyme Inhibitors and of Angiotensin II Receptor Blockers in Pharmacology and Therapy: An Update (Executive Editor: Agostino Molteni)]

“…Igic and Behnia [2] report the pharmacological, immunological and genetic targeting of the Renin-Angiotensin system for the treatment of cardiovascular diseases. The investigators present the various components of the Renin Angiotensin system (RAS), discuss the biological activities of angiotensin peptides and the role of the enzymes that generate and metabolize the various types of angiotensin.…”