Angiotensin-Converting Enzyme Inhibitors

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Abstract
Over many decades, the role of renin-angrotensin system in cardiovascular disorders has been redefined and expanded. Strongly interwoven with this process has been the development of pharmacologic probes that have helped to define this role. At the same time, these phannacologic probes have offered a clinically useful mechanism for inhibiting the renin-angiotensin system in patients with hypertension and heart failure. Most notable in this regard are the angiotensin-converting enzyme (ACE) inhibitors. Since the early use of ACE inhibitors 15 years ago, an expanding volume of data continues to define their role in heart failure. The complex biochemical activity, mechanisms of action, and pharmacodynamics of ACE inhibitors initially contributed to some reticence about their use in congestive heart failure (CHE). However, favorable long-term efficacy and mortality benefits observed initially in patients with severe CHF and subsequently, in patients with milder, and even asymptomatic heart failure, have now led to a widespread indication for ACF inhibitors in CHF. In addition to describing the mechanisms and pharmacodynamics in ACE inhibitors, this article summarizes clinical trials of ACE inhibitors in all stages of CHF.

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