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[Should cardiac insufficiency be first treated by angiotensin converting enzyme inhibitors?]
Insights
Angiotensin converting enzyme (ACE) inhibitors are the preferred treatment for chronic cardiac failure across all stages. These drugs offer symptomatic improvement and reduced mortality when used with diuretics and digitalis.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Chronic cardiac failure presents a significant public health challenge due to its high prevalence and mortality rates.
- Neurohormonal activation plays a critical role in the pathophysiology of cardiac failure.
Purpose:
- To critically evaluate the role of angiotensin converting enzyme (ACE) inhibitors as the "drug of choice" for chronic cardiac failure.
- To assess if ACE inhibitors meet Packer's criteria for optimal treatment: rapid symptom relief, mortality reduction, disease modification, efficacy, and tolerability.
Summary:
- Large-scale therapeutic trials (SOLVD, V-HeFT II, CONSENSUS II, SAVE) confirm the clinical benefits of ACE inhibitors.
- ACE inhibitors demonstrate symptomatic improvement and a reduction in mortality for severe cardiac failure.
- Results support the use of ACE inhibitors in all stages of chronic cardiac failure, particularly when combined with diuretic and digitalis therapy.
Impact:
- ACE inhibitors are confirmed as the drugs of choice for managing chronic cardiac failure.
- The findings support the integration of ACE inhibitors into comprehensive treatment regimens for cardiac failure.
- This evidence guides clinical practice towards optimizing patient outcomes in chronic cardiac failure.
Abstract:
Chronic cardiac failure is an important problem of public health because of its prevalence and high mortality. A better understanding of its physiopathology and the detrimental effect of neurohormonal activation that it induces were the reasons for the utilisation of angiotensin converting enzyme inhibitors leading to symptomatic improvement and also a reduction in the mortality of severe cardiac failure, as demonstrated in the CONSENSUS study published 5 years ago. Since then, cardiologists have presented ACE inhibitors in all stages of cardiac failure, but is this attitude justified? More explicitly, are ACE inhibitors the drugs of choice in cardiac failure? Before acknowledging this label "drug of choice" in the treatment of chronic cardiac failure, ACE inhibitors should fulfill certain reference criteria proposed by Packer for the treatment of this condition: rapid relief of symptoms; reduced mortality; modification of the natural history of the condition; efficacious and well tolerated. The effects of ACE inhibitors are analysed critically taking into account the results of large scale therapeutic trials (SOLVD, V-HeFT II, CONSENSUS II, SAVE), which have been reported recently? The reported results confirm clinical impressions: ACE inhibitors are the drugs of choice of all stages of chronic cardiac failure but in association with diuretic and digitalis therapy.