Heart failure and angiotensin converting enzyme inhibition: problems and perspectives

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Published on: June 29, 2014

F Simko1, J Simko

  • 1Department of Pathophysiology, Medical Faculty, and Center of Human Genetics, Faculty Hospital, Bratislava, Slovak Republic.

Physiological Research
|September 2, 1999
PubMed

Insights

Despite advances in heart failure treatment, many patients do not benefit from angiotensin converting enzyme (ACE) inhibitors. Understanding the renin-angiotensin system (RAS) and exploring new therapies is crucial for improving outcomes in chronic heart failure.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Heart failure remains a leading cause of mortality despite advancements in treatment.
  • Angiotensin converting enzyme (ACE) inhibitors have shown benefits, but approximately 80% of patients with chronic heart failure do not respond adequately.
  • Several factors contribute to the limited efficacy of ACE inhibitors, including variations in the renin-angiotensin system (RAS) and neuroendocrine activation.

Purpose of the Study:

  • To explore the reasons behind the high mortality in chronic heart failure patients despite ACE inhibitor treatment.
  • To identify alternative pathways and contributing factors to heart failure progression.
  • To highlight emerging therapeutic strategies for heart failure management.

Main Methods:

  • Review of existing literature on heart failure pathophysiology and treatment.
  • Analysis of factors influencing the renin-angiotensin system (RAS) and its role in heart failure.
  • Discussion of novel therapeutic targets beyond ACE inhibition.

Main Results:

  • Variations in tissue and systemic renin-angiotensin system (RAS) activation, alternative angiotensin II formation pathways (e.g., chymase), and genetic polymorphisms impact ACE inhibitor effectiveness.
  • Chronic heart failure can lead to peripheral vascular and muscle metabolism disturbances, exacerbating the condition.
  • New therapeutic avenues include angiotensin II type 1 receptor antagonists, beta-blockers, aldosterone antagonists, and endothelin receptor blockers.

Conclusions:

  • The complex interplay of factors within the renin-angiotensin system (RAS) and other neuroendocrine pathways contributes to the limited success of ACE inhibitors in a significant portion of heart failure patients.
  • Addressing these complexities and exploring novel therapeutic targets are essential for reducing mortality in chronic heart failure.
  • Further research into the renin-angiotensin system (RAS) holds promise for developing more effective heart failure treatments.

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