Angiotensin-converting enzyme inhibitors: congestive heart failure and beyond

Angiotensin-converting enzyme (ACE) inhibitors were introduced in the early 1980s as a novel class of agents to treat hypertension. Since that time, they have been proven to be a powerful tool in the treatment of symptomatic left ventricular systolic dysfunction. In this article we will summarize the results from clinical trials using ACE inhibitors in the treatment of heart failure and after myocardial infarction. We will discuss some of the mechanisms postulated to account for the beneficial effects associated with ACE inhibitor treatment. Finally, we will highlight some recent controversies in the use of ACE inhibitors.