[The role of ACE-inhibition in the therapy of chronic heart insufficiency].
It is now established that ACE-inhibitors are effective in the treatment of severe chronic heart failure; in addition to digitalis and diuretics. Furthermore, recent studies suggest, that beneficial effects of ACE-inhibitors can be expected in patients with moderate heart failure: when combined with diuretics. In atrial fibrillation, the combination with digitalis is recommended. Up to now, there is no clear evidence that monotherapy with ACE-inhibitors is superior to first line therapy with diuretics or digitalis. Nevertheless, initial (and limited) experience favors the use of ACE-inhibitors to prevent progressive LV-dysfunction following myocardial infarction. Based on experimental data, several additional mechanisms of action (besides unloading the heart) have been proposed; which may open up new indications for ACE-inhibition, such as antiarrhythmic, antiischemic or antiproliferative effects (including decreased incidence of coronary restenosis following angioplasty). If confirmed by clinical studies, the indications for ACE-inhibitors will expand considerably, putting emphasis on prevention of occurrence and progression of heart failure rather than treatment of very late stages of chronic heart failure. Yet, the Consensus trial demonstrated a significant impact of these agents on mortality in the latter patient population.
Drexler
H
H
Medizinischen Klinik III, Universität Freiburg, BRD.
Just
H
H
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D006332:Cardiomegaly / Q000188:drug therapy; D004071:Digitalis Glycosides / Q000008:administration & dosage; D004232:Diuretics / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D012084:Renin-Angiotensin System / Q000187:drug effects
D000806:Angiotensin-Converting Enzyme Inhibitors; D004071:Digitalis Glycosides; D004232:Diuretics
Stellenwert der ACE-Inhibition bei der Therapie der chronischen Herzinsuffizienz.