ACE inhibitors in early stages of heart failure

Chronic blockade of the renin-angiotensin system by angiotensin converting enzyme (ACE) inhibitors in patients with mild to moderate heart failure as a second-line therapy has been shown to exert beneficial effects on exercise tolerance and symptomatology.

Studies in experimental heart failure have shown that early inhibition of the renin-angiotensin-aldosterone system leads to a retardation in the progression of cardiac failure and improves survival. Recently, published data from large controlled trials also indicate that ACE inhibitors prolong survival in patients with mild and moderate heart failure. The beneficial effects of ACE inhibition, even in early phases of the genesis of heart failure, are mainly due to a reduction of the progression of pump failure, whereas the incidence of sudden cardiac death remains unchanged.

It can be concluded from these data that ACE inhibitors are no longer an add-on therapy in patients with mild to moderate heart failure but are clearly indicated for the treatment of symptomatic patients with mild heart failure as a first-line therapy.