Angiotensin converting enzyme inhibition in cardiovascular risk populations: a practical approach to identify the patient who will benefit most.
OBJECTIVE
Evidence from clinical trials suggests that angiotensin converting enzyme (ACE) inhibition has the broadest impact of any class of drugs in cardiovascular medicine, reducing cardiovascular morbidity and mortality. This beneficial effect varies across different patient populations, however. This review will summarize the current literature about the therapeutic potential of ACE inhibition and provide a practical approach for clinicians to identify patients who benefit most from ACE inhibition.


RESULTS
ACE inhibition has been shown to benefit patients with heart failure, left ventricular dysfunction, postmyocardial infarction, nephropathy, peripheral vascular disease, diabetes, stroke or transient ischemic attack. The absolute clinical benefit varies across different risk populations, however, depending on the patient characteristics. ACE inhibitors are most effective in patients with an increased cardiovascular risk associated with an activated renin-angiotensin system and less effective in patients with classical cardiovascular risk factors, but without an activated renin-angiotensin system.


CONCLUSIONS
We argue that markers of an activated renin-angiotensin system, such as left ventricular dysfunction, left ventricular hypertrophy, renal dysfunction, as assessed by estimated glomerular filtration rate, or urinary albumin excretion, may be used as targets and act as indicators for ACE-inhibition therapy and also for monitoring purposes. This will help clinicians to guide their therapy and identify patients who benefit most from ACE inhibition.
Asselbergs
Folkert W
FW
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
van Gilst
Wiek H
WH
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy*; D048909:Diabetes Complications / Q000188:drug therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers