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[Heart insufficiency and life expectancy--the role of ACE inhibitors]
1II. Medizinischen Klinik, Krankenhaus München-Schwabing, Ludwig-Maximilians-Universität München, BRD.
Insights
Angiotensin-converting enzyme (ACE) inhibitors show symptomatic improvement in congestive heart failure (CHF). Large trials are underway to confirm if ACE inhibitors improve long-term prognosis for CHF patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Established symptomatic improvement of congestive heart failure (CHF) with ACE inhibitors.
- Prognostic benefits of ACE inhibitors in CHF remain insufficiently demonstrated in large populations.
- Reliance on probabilistic data in clinical practice pending definitive evidence.
Purpose of the Study:
- To evaluate the impact of ACE inhibitors on the prognosis of symptomatic and asymptomatic left ventricular dysfunction.
- To assess the effect of ACE inhibitors on the progression of left ventricular dilatation.
- To compare ACE inhibitors with isosorbide dinitrate and hydralazine combination therapy.
Main Methods:
- Analysis of data from large-scale randomized trials, including SAVE and SOLVD.
- Inclusion of several thousand patients with varying degrees of left ventricular dysfunction.
- Comparative trial (VHEFT II) assessing ACE inhibitors against a combination therapy.
Main Results:
- Ongoing large-scale randomized trials (SAVE, SOLVD) are designed to provide definitive answers.
- Interim data and animal studies suggest a favorable influence of ACE inhibitors on CHF pathophysiology and symptomatology, potentially impacting prognosis.
- Results from VHEFT II will compare ACE inhibitors with ISDN/Hydralazine.
Conclusions:
- Definitive evidence on ACE inhibitor-mediated prognosis improvement in CHF is pending large trial results.
- Ongoing research aims to clarify the role of specific ACE inhibitors (Captopril, Enalapril) in managing left ventricular dysfunction and dilatation.
- Anticipated results within the early 2000s will guide clinical practice regarding ACE inhibitor use for CHF prognosis.
Abstract:
Before efficacy of therapy has been proven in large populations years or decades may pass. Meanwhile the medical profession has to rely on probabilities. This holds true regarding improvement of prognosis of CHF by ACE inhibition. While symptomatic improvement of CHF by addition of ACE-inhibition. While symptomatic improvement of CHF by addition of ACE-inhibitors has been demonstrated in numerous studies, improvement of prognosis has not yet been demonstrated entirely sufficiently. Only one trial has been published so far in a severely ill but not very exactly defined population (66). Animal studies and several small or interim published trials, however, show that the positive influence of ACE-inhibitors on CHF pathophysiology and symptomatology might favourable affect the prognosis as well. The SAVE trial and the SOLVD trial - both have randomized several thousand patients - will give answers concerning the influence of Captopril and Enalapril on prognosis of symptomatic as well as asymptomatic left ventricular dysfunction and on progression of left ventricular dilatation. The VHEFT II trial will compare the effect of ACE-inhibitors with the combination of ISDN and Hydralazine. Results will be available within the first few years of this decade.