Angiotensin-converting enzyme inhibition in mild to moderate congestive heart failure: an evolving approach

As a result of the understanding of the factors governing myocardial performance achieved in the physiology laboratory, vasodilator therapy was introduced for patients with refractory heart failure nearly two decades ago. Ten years later, investigations began with the first orally active angiotensin-converting enzyme inhibitor (ACEI), captopril, in patients with severe congestive heart failure (CHF). Subsequent studies have definitively demonstrated that ACEIs produce symptomatic and exercise tolerance improvement in patients with moderate and severe CHF. This favorable experience led to the investigation of captopril in patients with milder symptoms in whom the goals of treatment must be defined more rigorously. An optimal agent for this patient group would not only reduce symptoms, but improve prognosis and have demonstrable advantages over existing treatments. A growing body of investigational data and clinical experience indicates that the ACEIs achieve these goals. As a result, they are being used with increasing frequency in patients with milder grades of heart failure.