The Angiotensin-converting-enzyme (ACE) is involved in the Renin-angiotensin-aldosterone-system (RAAS) and stimulates the conversion of angiotensin-I to angiotensin-II. ACE inhibitors are competitive inhibitors of ACE, which prevent the conversion of angiotensin-I to angiotensin-II. Angiotensin-II acts as a potent vasoconstrictor that, when inhibited, can reduce blood pressure by dilating vessels and decreasing aldosterone secretion. Actions of angiotensin-II and aldosterone also lead to adverse cardiac remodeling. ACE inhibitors prevent adverse cardiac remodeling by reducing the concentrations of angiotensin-II and aldosterone. ACE inhibitors are widely used by clinicians/physicians to treat and manage hypertension, heart failure, stroke, coronary heart disease, patients with chronic kidney disease, and diabetes mellitus. Sanofi S.A., Gedeon Richter, Pfizer, Bristol-Myers Squibb, Novartis, and Merck (MSD) are the key players in the market for the drug class ACE inhibitor.
Key Developments:
- In Apr 2020, the University of Athens conducted a study to observe the effect of ACE inhibitors and the Sacubitril-Valsartan complex in bone marrow patients by assessing cardiovascular and endothelial parameters in order to search for a potential protective role.
- In Nov 2022, Novartis conducted an effective study of ARNI on ventricular arrhythmia in HFrEF patients with implanted ICD or CRT-D in China.
Approved Drug Molecules and Brand Names for ACE Inhibitors:
- ALTACE (Ramipril)
- VASOTEC (Enalapril)
- COVERSYL (Perindopril arginine)
- CAPOTEN (Captopril)
- LOTENSIN (Benazepril)
- MAVIK (Trandolapril)
- LOTREL (Amlodipine/Benazepril)
- MONOPRIL (Fosinopril)
- TRIPLIXAM (Perindopril arginine/Amlodipine/Indapamide)
- ACCUPRIL (Quinapril hydrochloride)
- COVERAM (Perindopril arginine+Amlodipine)
- LISONORM (Amlodipine/Lisinopril)
- TANATRIL (Imidapril)
- OCADRIK (Trandolapril/Verapamil)
Drugs under the Pipeline for ACE Inhibitors:
Cosimprel (Bisoprolol/Perindopril)
Enalapril Orodispersible Minitablet
Clinical Activity and Developments of ACE Inhibitors:
Currently, there are more than 20 drug products for ACE inhibitors, including both approved drugs in the market and drugs in clinical development phases.
- In Jan 2020, Pfizer conducted a phase-II clinical trial to observe the efficacy of Ramic (Ramipril) in heart patients with COVID-19 infections.
|
Molecule Name |
Number of Studies |
|
Cosimprel (Bisoprolol/Perindopril) |
5 |
|
Enalapril Orodispersible Minitablet |
3 |
Target Indication Analysis of ACE Inhibitors:
ACE inhibitors are useful as adjunctive therapy in systolic heart failure patients who also have a history of myocardial infarction. ACE inhibitors can be used to treat hypertension either alone or in conjunction with other anti-hypertensives to lower blood pressure. It is also recommended as part of a regimen in patients with hypertension and chronic stable angina if there is a history of left ventricular dysfunction, diabetes mellitus, or chronic kidney disease. ACE inhibitors should be initiated within 24 hours of ST-elevated myocardial infarction, specifically in patients with anterior myocardial infarction, heart failure, or left ventricular ejection fraction of 40% or less. The addition of an ACE inhibitor has shown a significant reduction in serum creatinine in hypertensive and normotensive patients with albuminuria. ACE inhibitor therapy has shown a significant decrease in the progression of diabetic nephropathy.
Regional Analysis of ACE Inhibitors:
ACE Inhibitors Market
AstraZeneca sold the global commercial rights for Zestril (Lisinopril), and Zestoretic (Lisinopril/Hydrochlorothiazide) with others worth US$ 350 million to Atnahs Pharma. Aurobindo Pharma USA, Inc. initiated a voluntary nationwide recall of two lots of Quinapril/Hydrochlorothiazide tablets due to the detection of N-Nitroso Quinapril impurity which led to restraining the growth of the company. Cardiovascular diseases (CVD) are the leading cause of death globally. According to the World Health Organization Report 2020, an estimated 17.9 million deaths were attributed to CVD globally, with the highest mortality rate in Eastern Europe and Central Asia. Globally, it was estimated that in 2020, 244.1 million people were living with ischemic heart disease, being more prevalent in males (141.0 million) and North Africa, the Middle East, Central and South Asia, and Eastern Europe had the highest prevalence rate in 2020. The global prevalence rate of stroke in 2020 was 89.1 million with the highest prevalence rates in Southeastern United States and East and Southeast Asia. Based on 2020 data, age-standardized mortality rates attributed to high systolic blood pressure were highest in Central and Southeast Asia, Eastern, and Central Europe, and parts of Africa and the Middle East. The age-standardized prevalence rate of diabetes was highest in high-income North America, the Middle East, and Central Latin America with an overall 472 million patients.
Latin America
Europe
Asia Pacific
Middle East
North America
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Frequently Asked Questions
GALTACE (Ramipril), VASOTEC (Enalapril), COVERSYL (Perindopril arginine), CAPOTEN (Captopril), LOTENSIN (Benazepril), MAVIK (Trandolapril), are the few approved ACE inhibitors.
The global death burden for cardiovascular diseases was 17.9 million in 2020.
Sanofi S.A., Gedeon Richter, Pfizer, Bristol-Myers Squibb, Novartis, and Merck (MSD) are the major market players for the drug class ACE inhibitors.
Major indications for ACE Inhibitors are hypertension, heart failure, stroke, coronary heart disease, chronic kidney disease, and diabetes mellitus.
- Novartis AG (Switzerland)
- Bristol-Myers Squibb Company (USA)
- AbbVie Inc. (USA)
- AstraZeneca (UK)
- Merck (MSD) (USA)
- Sanofi S.A. (France)
- Pfizer Inc. (USA)