ACE-inhibitors in the treatment of chronic heart failure: pathophysiologic principles of protective effects
Simko, F.; Riecanský, I.
Bratislavske Lekarske Listy 97(10): 583-586
1996
ISSN/ISBN: 0006-9248 PMID: 9019340 Document Number: 463596
The aim of modern therapy of heart failure is not a pure removal of symptoms but an improvement of survival. The angiotensin-converting enzyme (ACE)-inhibitors reduced morbidity and mortality in several large clinical trials in patients with dysfunctional left ventricle or manifestant heart failure. Thus, ACE inhibitors are recommended for heart failure treatment as a drug of primary option, unless contraindications are present, and if tolerated by patient. The mechanism of action of ACE inhibitors in heart failure is hypothetical. Participation of three factors is supposed: improvement in the pumping function of the failing heart, reduction on the risk of sudden death and reduction in myocardial infarction incidence. Reduction of hemodynamic load, antiischemic action and reduction of fibrotic tissue proliferation in failing myocardium are responsible for heart function improvement. These mechanisms together with potential antiatherosclerotic, antiaggregative, fibrinolytic and protective effect on endothelial function are supposed to participate in reduction of acute myocardial infarction and sudden death origin. The mentioned effects are determined by interaction with both circulating and local renin-angiotensin systems. The negative hemodynamic effects and undesirable restructuralisation of the affected ventricle are thus influenced on systematic and local-tissue level. Similarly as any other therapy also the treatment of heart failure with ACE inhibitors needs experience and a rational well tailored individual approach. (Fig.1, Ref. 32.).