Regitz-Zagrosek V, Fielitz J, Fleck E
Klinik für Kardiologie, DHZB und Charite, Berlin, Germany.
Basic Res Cardiol. 1998;93 Suppl 2:37-42. doi: 10.1007/s003950050207.
The cardiac renin angiotensin system (RAS) is the target for number of therapeutic interventions which proved successful in heart failure. Angiotensin converting enzyme (ACE) inhibitors belong to the most efficient strategies available and angiotensin receptor (ATR) antagonists may be comparably effective. The direct myocardial effects of both classes of substances depend on the cardiac ANG II receptors. Both subtypes, AT1 and AT2, are expressed in the human heart. AT1 is localized on myocytes, non-myocytes, vascular smooth muscle and endothelial cells, nerve endings, and conduction tissues. AT2 has so far been found in fibrous tissue and endothelial cells. AT1 mediates myocyte hypertrophy, fibroblast proliferation, collagen synthesis, smooth muscle cell growth, endothelial adhesion molecule expression, and catecholamine synthesis. AT1 is downregulated in cardiac failure as well as in the hypertrophied transplanted heart, indicating that a 50% loss of AT1 does not impede cardiac hypertrophy. In heart failure therapy, AT1 antagonists differ from ACE inhibitors by their inhibition of the degradation of bradykinin. Bradykinin has a number intrinsic effect including vasodilation, proinflammatory actions, and modulation of fibrous tissue synthesis. In addition to bradykinin, the functional role of AT2 seems crucial for the therapeutic differences of AT1 antagonists versus ACE inhibitors.
