The evolving role of angiotensin-converting enzyme inhibition in heart failure: expanding the protective envelope.
Congestive heart failure (CHF) continues to be a major cause of morbidity and mortality; in the United States alone, CHF afflicts 4 million patients, representing about 2% of the adult population; causes or contributes to more than 250,000 deaths yearly; and is the principal or secondary diagnosis in 6% of all hospital discharges. After the discovery of angiotensin-converting enzyme (ACE) inhibitors as potent antihypertensive agents, an increased understanding of the pathophysiology of CHF, in addition to the recognition of heart failure as a process that evolves through time, led to the use of these agents in patients with CHF. Subsequently, a series of multicenter trials systematically explored the role of ACE-inhibitor therapy in heart failure. The purpose of this review is to discuss some of these trials and to describe the answers that they provide to the following questions: Are vasodilators beneficial in the treatment of severe heart failure? Are ACE inhibitors beneficial in mild-to-moderate heart failure? Which vasodilator regimen (ACE inhibitors or hydralazine/isosorbide dinitrate) is more effective? Finally, are ACE inhibitors beneficial in asymptomatic patients at risk of heart failure?
Teerlink
J R
JR
Department of Internal Medicine, University of California, San Francisco 94143.
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009203:Myocardial Infarction / Q000473:pathology; D012307:Risk Factors; D014481:United States; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
D000806:Angiotensin-Converting Enzyme Inhibitors; D014665:Vasodilator Agents