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Modern treatment of patients at risk: still a HOPE for ACE inhibitors?

Fabio Angeli, Gianpaolo Reboldi, Paolo Verdecchia

    Expert Opinion on Pharmacotherapy
    |February 18, 2011
    PubMed

    Insights

    Angiotensin-converting enzyme (ACE) inhibitors are vital for heart failure and kidney disease. While beneficial in heart failure, their role in vascular disease with preserved function requires further examination.

    Area of Science:

    • Cardiology
    • Pharmacology
    • Nephrology

    Background:

    • Angiotensin-converting enzyme (ACE) inhibitors are indicated for heart failure, post-myocardial infarction, diabetes mellitus, and proteinuric chronic renal disease.
    • These drugs offer life-saving benefits in patients with heart failure or left ventricular systolic dysfunction.
    • Conflicting data exist on ACE inhibitors' ability to reduce cardiovascular events in patients with vascular disease and preserved left ventricular systolic function.

    Discussion:

    • This editorial reviews randomized clinical trials evaluating ACE inhibitors in patients with vascular disease.
    • It examines the differential prognostic impact of ACE inhibitors in high-risk patients, with and without heart failure or preserved left ventricular systolic function.
    • The influence of lipids and statins on ACE inhibitor efficacy is also discussed.

    Key Insights:

    • ACE inhibitors demonstrate clear benefits in established heart failure and systolic dysfunction.
    • Evidence for cardiovascular event reduction in vascular disease with preserved systolic function remains debated.
    • The prognostic impact varies significantly based on the presence of heart failure or preserved left ventricular systolic function.

    Outlook:

    • ACE inhibitors remain crucial for patients with coronary artery disease or high vascular risk.
    • Continued use is recommended even with modern, aggressive preventive strategies.
    • Further research may clarify optimal use in specific vascular disease phenotypes.

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