ACE inhibitors improve survival over placebo or direct-acting vasodilators in patients with NYHA class II-IV congestive heart failure and post-myocardial infarction left ventricular dysfunction.
Does the use of ACE inhibitors and other vasodilators improve survival in patients with congestive heart failure or post-myocardial infarction left ventricular dysfunction?
This review highlights the paradigm shift in heart failure management toward the foundational use of ACE inhibitors to improve survival in both symptomatic CHF and asymptomatic post-MI left ventricular dysfunction.
As understanding of the mechanisms of congestive heart failure (CHF) has improved, it has become apparent that the previously applied stepped-care approach (ie, diuretic, digitalis, then vasodilator) is no longer valid. There is compelling evidence that use of vasodilators increases survival in CHF, and angiotensin-converting enzyme (ACE) inhibitors are the vasodilators of choice. Use of an ACE inhibitor in patients with New York Heart Association classes II, III, and IV CHF improves survival over that achieved with use of placebo or direct-acting vasodilators. In patients with asymptomatic left ventricular dysfunction after myocardial infarction, long-term administration of captopril improved survival and reduced morbidity and mortality from major cardiovascular events. Using an ACE inhibitor as preventive therapy in post-myocardial infarction patients without overt CHF but with evidence of muscle dysfunction (ie, left ventricular ejection fraction 40% or less) should be considered. The role of a newer vasodilator (eg, amlodipine besylate Norvasc) as an adjunct to therapy remains to be defined. If current theories on the pathophysiology of CHF are correct, continued interest in beta blockers is justified, especially in newer agents that have actual vasodilatory action in addition to their other beneficial properties.
Jennison et al. (Fri,) conducted a review in Congestive heart failure. ACE inhibitors vs. Placebo or direct-acting vasodilators was evaluated on Survival and major cardiovascular events. ACE inhibitors improve survival over placebo or direct-acting vasodilators in patients with NYHA class II-IV congestive heart failure and post-myocardial infarction left ventricular dysfunction.
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