Hypertension, known as high blood pressure, affects over one billion people worldwide and is a leading cause of cardiovascular diseases, particularly in low- and middle-income countries. Despite widespread use of medications to manage this condition, many remain at risk due to inadequate control of their blood pressure.

A recent study published in *Hypertension Research* from researchers at the University of Pennsylvania highlights a startling connection between commonly prescribed medications and a naturally occurring enzyme, ACE2, which may hold the key to better managing hypertension.

What Are ACE Inhibitors and ARBs?

ACE inhibitors and angiotensin receptor blockers (ARBs) are the go-to treatments for high blood pressure. They work by interfering with the body's renin-angiotensin system (RAS), which plays a critical role in regulating blood pressure levels. ACE inhibitors prevent the formation of angiotensin II, a substance that narrows blood vessels, while ARBs stop angiotensin II from binding to its receptors.

A Surprising Twist in the Research!

In this groundbreaking study, the researchers investigated the impact of adding oral ACE2—previously shown to help with metabolic diseases—alongside traditional treatments. To their shock, they discovered that ACE inhibitors were actually inhibiting the very ACE2 enzyme they hoped would assist in lowering blood pressure. Additionally, ARBs were found to increase the levels of angiotensin II, directly countering their intended effect!

This revelation raises significant concerns as inhibiting ACE2 and boosting angiotensin II are counterproductive for patients striving to manage their blood pressure effectively. However, there's some good news: not all ACE inhibitors have the same detrimental effect on ACE2. Lisinopril, a commonly prescribed drug, showed markedly less inhibition of ACE2 compared to others.

Potential Links to COVID-19?

The insights gained from this study not only impact hypertension treatment but also connect to broader health concerns related to COVID-19. The inhibition of ACE2 has been implicated in the severity of SARS-CoV-2 infections, suggesting that maintaining ACE2 activity could be crucial for various health outcomes.

What's Next for Research?

The researchers are eager to expand their findings by evaluating the effects of lisinopril in future studies. Their ultimate goal is to explore the potential of ACE2 treatment in humans, especially now that the FDA has approved the use of their innovative plant-based delivery system for clinical trials. As it stands, ACE2 could become the first biologically engineered human protein derived from plants to undergo human testing, heralding a new era in cardiac therapy!

This study not only sheds light on the complexities of blood pressure treatment but could also pave the way for safer, more effective therapies that harness the protective power of ACE2.