Which patients with heart failure require an ACE inhibitor?

Angiotensin-converting enzyme (ACE) inhibition is indicated in all patients with ventricular dysfunction, whether asymptomatic (New York Heart Association [NYHA] class I) or symptomatic (NYHA classes II to IV). ACE inhibition delays progression to severe heart failure, decreases mortality and the frequency of hospitalization, enhances functional capacity and quality of life in symptomatic patients, and improves prognosis in asymptomatic patients with mild-to-moderate left ventricular dysfunction (ejec-

Further reading

The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators.

Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet. 1993,342:821 -828. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293-302.

The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. 1992;327:685-691.

Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium. Fibrosis and renin-angiotensin-aldosterone system. Circulation. 1991 ;83:1849-1865.

Keywords

drug; ACEI; left ventricular dysfunction; remodeling; quality of life

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