Angiotensin-converting enzyme inhibitors in the treatment of clinical heart failure

During the last decade, angiotensin-converting enzyme inhibitors (ACE-I) have become cornerstones in the treatment of clinical congestive heart failure. There is convincing evidence that they improve survival and that, in this respect, they are superior to ordinary vasodilators. ACE-I administration also improves New York Heart Association functional class and the left-ventricular function, but their long-term effects on exercise tolerance and quality of life appear modest. During prolonged administration to patients with ischemic left-ventricular dysfunction, ACE-I also significantly reduce the incidence of new ischemic events (myocardial infarction, unstable angina).