Dzau V J
Falk Cardiovascular Research Center, Stanford University School of Medicine.
J Hypertens Suppl. 1994 Jul;12(4):S3-10.
GROWTH-PROMOTING EFFECTS OF ANGIOTENSIN: Angiotensin, a vasoconstrictive peptide, is now known to be an agent of vascular and cardiac growth and may directly influence the pathophysiology of coronary artery disease and ventricular remodeling. Vascular growth occurs when angiotensin activates autocrine and paracrine growth factors, including fibroblast growth factor, transforming growth factor beta-1 and platelet-derived growth factor, and is modulated by endothelium-derived vasodilators and growth inhibitors. ANGIOTENSIN AND CARDIOVASCULAR DISEASE: The presence of angiotensin converting enzyme (ACE) and angiotensin II has been demonstrated in vascular tissue, and these local substances are causally involved in the development of vascular lesions. Similarly, angiotensin can stimulate cardiac myocyte growth and matrix modulation. Cardiac tissue ACE is implicated in ventricular remodeling in the course of progressive heart failure. A genetic variant of the ACE gene has been reported to be associated with increased risks of cardiovascular pathology. ACE INHIBITOR THERAPY: To date, studies of ACE inhibitor treatment in human patients have not demonstrated any prevention of restenosis after angioplasty. However, recent clinical trials in postmyocardial infarction reported that ACE inhibitor therapy reduces recurrent myocardial infarction and prevents cardiac enlargement. Long-term prospective trials are currently being conducted to examine the effects of ACE inhibitor therapy on coronary ischemic events and coronary atherosclerosis, as evaluated by angiography or intravascular ultrasound, and the relationship between coronary events and ACE gene polymorphism.
血管紧张素是一种血管收缩肽，现在已知它是血管和心脏生长的介质，可能直接影响冠状动脉疾病和心室重构的病理生理学。当血管紧张素激活自分泌和旁分泌生长因子（包括成纤维细胞生长因子、转化生长因子β-1和血小板衍生生长因子）时，血管生长就会发生，并受到内皮衍生的血管舒张剂和生长抑制剂的调节。
血管组织中已证实存在血管紧张素转换酶（ACE）和血管紧张素II，这些局部物质与血管病变的发生有因果关系。同样，血管紧张素可刺激心肌细胞生长和基质调节。心脏组织ACE与进行性心力衰竭过程中的心室重构有关。据报道，ACE基因的一种遗传变异与心血管病理风险增加有关。
ACE抑制剂治疗：迄今为止，在人类患者中进行的ACE抑制剂治疗研究尚未证明对血管成形术后再狭窄有任何预防作用。然而，最近关于心肌梗死后的临床试验报告称，ACE抑制剂治疗可减少复发性心肌梗死并预防心脏扩大。目前正在进行长期前瞻性试验，以通过血管造影或血管内超声评估ACE抑制剂治疗对冠状动脉缺血事件和冠状动脉粥样硬化的影响，以及冠状动脉事件与ACE基因多态性之间的关系。
