Angiotensin-Converting Enzyme Inhibitors in Congestive Heart Failure

The angiotensin-converting enzyme (ACE) inhibitors are of proven benefit in patients with severe grades of heart failure who are already on baseline treatment with diuretics. Under these circumstances they have been shown, in controlled prospective studies, to be superior to placebo and also to other vasodilators. Many areas of uncertainty remain, however, and some of these were addressed at the Cambridge Conference. This brief overview summarizes the views expressed by delegates. It was recognized that heart failure is a heterogeneous disorder in relation to etiology, severity, outlook, and associated clinical and biochemical abnormalities. Each patient, therefore, must be treated on an individual basis, and general rules will need to be modified according to the particular requirements of the individual. No formal attempt was made to assess preferences for individual ACE inhibitors in heart failure, and indeed this would have been impractical because many clinicians were familiar with only one agent.