Potential Noncardiac, Nonrenal Uses of Angiotensin-converting Enzyme Inhibitors

Samir Malhotra, Promilla Pandhi

August 07, 2002

In This Article

Introduction

The evaluation of the renin-angiotensin system began with the discovery of renin in 1898 by Tiegerstedt and Bergman[1] and was followed by the observation in 1940 that renin acted on a plasma protein substrate to catalyze the formation of a pressor peptide. This peptide was known by 2 different names, angiotonin and hypertensin, and was later renamed angiotensin.[1] Its plasma precursor was also renamed and is now known as angiotensinogen. Two forms of angiotensin, angiotensin I and II, were recognized in the mid 1950s. The conversion of inactive angiotensin I to the active angiotensin II occurs via angiotensin-converting enzyme (ACE).[1,2] Since the initial discoveries, efforts to manipulate the renin-angiotensin system resulted in the synthesis of the first orally effective ACE inhibitor, captopril.[3] A series of other ACE inhibitors have now been synthesized.[4]

ACE inhibitors are useful in the treatment of a variety of cardiac and renal disorders ( Table 1 ), and therefore are widely used.[5] It is this widespread use that has led to the recognition of several other clinical situations in which ACE inhibitors may be beneficial. This review attempts to summarize the potential noncardiac, nonrenal uses of this group of drugs. Clinical situations that may benefit from ACE inhibitor therapy include:

  • migraine prophylaxis

  • polycythemia

  • glaucoma

  • aging

  • Alport syndrome

  • nephrotic syndrome

  • dialysis-induced peritoneal fibrosis

  • chronic mercury intoxication

  • Parkinson's disease

  • ovarian hyperstimulation syndrome

  • male infertility

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