[Value of ACE inhibitors in heart failure (clinical aspects)]

The use of ACE-inhibitors in patients with severe congestive heart failure is established on the basis of the results of the CONSENSUS I-study, which has shown that ACE-inhibitors in patients in NYHA class IV not only have improved functional parameters, but also improved survival. Recently published controlled data from studies including patients with mild to moderate heart failure (SOLVD-study) show a significant improvement of mortality in this subgroup. Comparing placebo and ACE-inhibitors, the effect of ACE-inhibitors on mortality is due to a reduction of progression of pump failure. Comparing vasodilator-therapy (hydralazine/isosorbide dinitrate) and ACE-inhibition in the V-HeFT II-trial showed, despite a transient increase in ejection fraction and exercise capacity during the vasodilator-therapy, a significant improvement in survival in the patients treated with an ACE-inhibitor. This was achieved by a reduction of the incidence of sudden cardiac death. From these recent data it can be concluded that ACE-inhibition is the therapy of choice in patients with mild to severe heart failure.