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[ACE-inhibitors in the treatment of chronic heart failure: pathophysiologic principles of protective effects]
1Ustav patologickej fyziológie Lekárskej fakulty Univerzity Komenského v Bratislave, Slovakia.
Insights
Angiotensin-converting enzyme (ACE) inhibitors improve survival in heart failure patients by enhancing heart function and reducing risks of sudden death and heart attack. These drugs are a primary treatment option, impacting both systemic and local renin-angiotensin systems.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Heart failure therapy aims to improve survival, not just manage symptoms.
- Angiotensin-converting enzyme (ACE) inhibitors have demonstrated significant reductions in morbidity and mortality in clinical trials for heart failure patients.
Purpose:
- To outline the role and hypothetical mechanisms of ACE inhibitors in heart failure treatment.
- To emphasize ACE inhibitors as a primary therapeutic option for heart failure when contraindications are absent and patient tolerance is good.
Summary:
- ACE inhibitors are recommended for heart failure due to their ability to reduce mortality and morbidity.
- Hypothesized mechanisms include improved cardiac pumping function, reduced risk of sudden death, and decreased myocardial infarction incidence.
- These effects are linked to the inhibition of renin-angiotensin systems, influencing hemodynamics and myocardial structure.
Impact:
- ACE inhibitors positively influence cardiac function by reducing hemodynamic load, exhibiting anti-ischemic effects, and mitigating fibrotic tissue proliferation.
- Potential benefits include antiatherosclerotic, antiaggregative, fibrinolytic, and endothelial protective actions, contributing to reduced myocardial infarction and sudden death.
- Treatment requires an individualized approach, considering the drug's interaction with systemic and local renin-angiotensin systems to manage adverse hemodynamic effects and ventricular remodeling.
Abstract:
The aim of modern therapy of heart failure is not a pure removal of symptoms but an improvement of survival. The angiotensin-converting enzyme (ACE)-inhibitors reduced morbidity and mortality in several large clinical trials in patients with dysfunctional left ventricle or manifestant heart failure. Thus, ACE inhibitors are recommended for heart failure treatment as a drug of primary option, unless contraindications are present, and if tolerated by patient. The mechanism of action of ACE inhibitors in heart failure is hypothetical. Participation of three factors is supposed: improvement in the pumping function of the failing heart, reduction on the risk of sudden death and reduction in myocardial infarction incidence. Reduction of hemodynamic load, antiischemic action and reduction of fibrotic tissue proliferation in failing myocardium are responsible for heart function improvement. These mechanisms together with potential antiatherosclerotic, antiaggregative, fibrinolytic and protective effect on endothelial function are supposed to participate in reduction of acute myocardial infarction and sudden death origin. The mentioned effects are determined by interaction with both circulating and local renin-angiotensin systems. The negative hemodynamic effects and undesirable restructuralisation of the affected ventricle are thus influenced on systematic and local-tissue level. Similarly as any other therapy also the treatment of heart failure with ACE inhibitors needs experience and a rational well tailored individual approach. (Fig.1, Ref. 32.).