Several large, prospective, randomized, placebo-controlled trials have demonstrated that treatment with Angiotensin Converting Enzyme (ACE) inhibitors results in a reduction in overall mortality in human and small animal, patients with heart failure. ACE regulates the balance between the vasoconstrictive, salt-retensive, and hypertrophic properties of angiotensin II and the vasodilatory and naturetic properties of bradykinin. ACE inhibitors alter this balance by decreasing the formation of angiotensin II and the degradation of bradykinin. ACE inhibitors also indirectly alter the metabolism of a number of other vasoactive substances and diuretic hormon; NO, prostagrandin, and endothelin, and ADH, etc. ACE inhibitors decrease systemic vascular resistance but cause little change in heart rate. ACE inhibitors have effect on cardiac output or pulmonary capillary wedge pressure. It is clear that ACE inhibitors represent one of major advances in cardiovascular therapeutics in small animal cardiovascular medicine.
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