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European Heart Journal 1990 11(Supplement D):27-32; doi:10.1093/eurheartj/11.suppl_D.27
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

Haemodynamic effects of ACE inhibitors

G. Mancia, R. Perondi, A. Saino, R. Tio, G. Pomidossi, L. Gregorini and A. Zanchetti

Cattedra di Semeiotica Medica and Istituto di Clinica Medica, Università di Milano; Centro di Fisiologia Clinica e Ipertensione, Ospedale Maggiore, and Centro Auxologico Italiano Milano, Italy

Address for correspondence: Professor Giuseppe Mancia, MD, Centro Fisiologia Clinica e Ipertensione, Via F. Sforza 35, 20122 Milano, Italy

This paper reviews the haemodynamic effects of angiotensin-converting enzyme (ACE) inhibitors in hypertension, focusing on their ability to cause a fall in systemic vascular resistance, with no change in cardiac output and no reduction and even an increase in blood flow to vital organs such as the brain, the kidney and the heart. The haemodynamic efects of ACE inhibitors are qualitatively similar in congestive heart failure, except that, in the presence of impaired cardiac function, the fall in resistance is accompanied by a pronounced increase in cardiac output and tissue perfusion. In both conditions ACE inhibition opposes sympathetic influences and enhances vagal influences and, in hypertension, this intervention is followed by a regression of left ventricular hypertrophy providing a multifold background for a cardioprotective action. The new ACE inhibitor quinaprill appears to share the haemodynamic effects of other ACE inhibitors with an improvement of cardiovascular function in congestive heart failure.

Key Words: ACE inhibitors • congestive heart failure • hypertension • left ventricular hypertrophy • quinapril • sympathetic nervous system


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