Angiotensin-converting enzyme inhibitors in the clinical setting of chronic congestive heart failure.
The addition of an angiotensin-converting enzyme (ACE) inhibitor to digitalis and diuretics in chronic congestive heart failure (CHF) prolongs survival and improves the clinical condition of patients. These actions depend on the inhibition of ACE and are, therefore, common to all ACE inhibitors. Thus, the inclusion of an ACE inhibitor in the therapeutic regimen of chronic CHF is mandatory, whenever feasible. The use of ACE inhibitors in chronic CHF should avoid symptomatic hypotension and inordinate decreases in renal function. To this end, ACE inhibitor therapy should progress by gradually increasing doses, and sodium intake and dosages of diuretics and ACE inhibitors should be adjusted in the light of changing circumstances. ACE inhibitors with short elimination half-lives should be preferred in chronic CHF, since they allow quicker dose adjustment than their longer-acting congeners, and given that compliance with once and twice daily dosing would be similar.
Reyes
A J
AJ
Institute of Cardiovascular Theory, Montevideo, Uruguay.
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002908:Chronic Disease; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007189:Indans / Q000493:pharmacokinetics / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D007189:Indans; C047759:delapril