How ACE inhibitors transformed the renin–angiotensin system

Bakhle, Y.S.

doi:10.1111/bph.15045

Cited by 41Renin-Angiotensin System StudiesHistorical Medical Research and TreatmentsHistory of Science and Medicine

How ACE inhibitors transformed the renin–angiotensin system

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Bakhle, Y.S.·2020·British Journal of Pharmacology

DOI 10.1111/bph.15045PMC PMC7236071

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Abstract

The renin–angiotensin system (RAS) now underlies the successful treatment of almost 50% of the patients in cardiovascular medicine, with serious possibilities of extension to diabetes, Alzheimer's disease and cancer. This clinical transformation started just over 50 years ago, with the unexpected identification of a bradykinin‐potentiating peptide from snake venom, as a potent inhibitor of ACE which led to the development of the first synthetic inhibitor, captopril, followed by the angiotensin receptor blockers. This article analyses the transformation of the RAS into its different stages, from academic experiments to clinical use and back to the laboratory, identifying the critical events involved, both clinical and scientific. The analysis also assesses the contributions of chance, coincidence, and conviction that were crucial in this transformation. Although questions remain, the transformation of the RAS over the past five decades provides a success story for medicine, for pharmacology, and, most significantly, for patients.

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Excessive activity of renin or ACE leads to high angiotensin II levels, causing abnormal vessel constriction and reduced vasodilation.
“Excessive activity of renin or ACE leads to high levels of angiotensin II, causing abnormal vessel constriction and reduced vasodilation [45].”
From Navigating the potential of algal peptides: health effects, market applications, and scientific challenges (2026) · cites this paper as [45]

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Authors: Bakhle, Y. S.
Affiliations: Imperial College London (GB)
Corresponding author: Bakhle, Y.S.
Venue: British Journal of Pharmacology
Publisher: Wiley
Published: 2020-04-12
Volume: 177
Issue: 12
Pages: 2657-2665
ISSN: 0007-1188 (ISSN-L)
1476-5381
DOI: 10.1111/bph.15045
PMC: PMC7236071
OpenAlex: W3010182921
Cited by: 41
References: 84
Citations by year: 2026: 5 · 2025: 6 · 2024: 7 · 2023: 6 · 2022: 7 · 2021: 4 · 2020: 6
FWCI: 1.02
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: British Journal of Pharmacology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Historical Medical Research and Treatments
Social Sciences › Arts and Humanities › History and Philosophy of Science › History of Science and Medicine
Keywords: renin-angiotensin system, ACE inhibitors, captopril, angiotensin receptor blockers, bradykinin-potentiating peptides, snake venom, drug development history, cardiovascular disease treatment, diabetes mellitus, Alzheimer's disease, cancer
MeSH terms: Angiotensin-Converting Enzyme Inhibitors, Captopril, Diabetes Mellitus, Humans, Hypertension, Renin-Angiotensin System, Angiotensin Receptor Antagonists

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How ACE inhibitors transformed the renin–angiotensin system

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