Angiotensin II (Ang II) increases adhesion molecules, cytokines and chemokines and exerts a proinflammatory effect on leucocytes, endothelial cells and vascular smooth muscle cells. Acting via the type 1 receptor, Ang II initiates an inflammatory cascade of reduced nicotinamide-adenine dinucleotide phosphate oxidase, reactive oxygen species (ROS) and nuclear factor-κB, which mediates transcription and gene expression and increases adhesion molecules and chemokines. An excess of ROS decreases nitric oxide bioavailability, causes endothelial dysfunction, and promotes atherosclerosis. Moreover, Ang II interrupts the anti-inflammatory effects of insulin. Together, these effects promote a prothrombotic state as well as plaque rupture. Ang II receptor blockers suppress mediators of inflammation, including ROS and C-reactive protein, and they increase expression of inhibitory κB (an inhibitor of nuclear factor-κB). These anti-inflammatory and antioxidative effects, which are probably due in part to unopposed stimulation of the Ang II type 2 receptor, may be beneficial in acute coronary syndromes and may also contribute to the prevention of type II diabetes mellitus, as insulin resistance is mediated by inflammatory processes.
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Search strategy: PubMed was used to review literature related to the effect of ACE inhibition and angiotensin II receptor blockade on inflammation. Keywords angiotensin, inflammation, ARB and ACE were used in the search. Search was limited to humans.
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Dandona, P., Dhindsa, S., Ghanim, H. et al. Angiotensin II and inflammation: the effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockade. J Hum Hypertens 21, 20–27 (2007). https://doi.org/10.1038/sj.jhh.1002101
- angiotensin II
- angiotensin II receptor blockers
- oxidative stress
- nuclear factor-κB
- reactive oxygen species
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