Calcium Antagonists and ACE Inhibitors

Summary

The effects of cardiovascular drugs on endothelium and vascular smooth muscle function are important for the prevention of cardiovascular disease. Changes in endothelial function are an early event in most forms of cardiovascular disease and, later in the disease process, vascular smooth muscle cells are functionally altered and begin to migrate to and proliferate in the intima. Calcium antagonists and angiotensin converting enzyme (ACE) inhibitors are widely used in patients with cardiovascular disease and are thought to have vascular protective effects. ACE, an enzyme located in the endothelial cell membrane, activates angiotensin I and angiotensin II, and deactivates bradykinin. Bradykinin activates endothelial bradykinin (B₂) receptors, which results in the formation of nitric oxide and prostacyclin. Hence, ACE inhibitors not only prevent the formation of angiotensin II, but also increase the local levels of bradykinin and in turn nitric oxide and prostacyclin. These compounds are vasodilators and potent inhibitors of platelet function, and therefore may mediate important protective effects of ACE inhibitors. Furthermore, nitric oxide may have antiproliferative effects in vascular smooth muscle cells.

Calcium antagonists do not appear to affect the release of endothelium-derived relaxing factors or any other endothelial product. However, they facilitate endothelium-dependent relaxation and reduce the contracting effects of endothelin-1 at the level of smooth muscle. Indeed, in some blood vessels, e.g. the large coronary arteries and the human forearm circulation, verapamil and nifedipine antagonise endothelin-induced contractions. In addition, calcium antagonists inhibit the effects of platelet-derived growth factor and may have antiproliferative effects in vascular smooth muscle cells. In conditions involving progressive dysfunction of the endothelium, vascular deposition of platelets increases the local levels of platelet-derived growth factor, and the antiproliferative effects of calcium antagonists may thus be particularly important.