[Effects of angiotensin-converting enzyme inhibitors in heart failure]

A critical review of the medical treatment of heart failure reveals an insufficient efficacy of conventional therapy, associated with a lack of effect regarding improved survival. Inclusion of vasodilating substances into the regimen, for reduction of left ventricular impedance, offers the possibility of further improving the quality of life of patients with severe heart failure. In addition, some of these substances have now been proved to alter not only the quality but also the quantity of life in a beneficial way. Among the various vasodilators, ACE-inhibitors appear to exhibit a specific spectrum of effects that may contribute to the prolongation of survival in these patients. In particular, correction of hyponatremia, positive potassium and magnesium balance, reduction in the activity of vasopressor and volume retaining systems, as well as their potential anti-ischemic and antiarrhythmic effects, are plausible candidates for beneficially interfering with the progression of the disease. These documented effects make this type of therapy an invaluable inclusion in the modern treatment of heart failure.