Drug therapy for chronic heart failure due to left ventricular systolic dysfunction: a review. III. Angiotensin-converting enzyme inhibitors.

The role of angiotensin-converting enzyme inhibitors (ACEIs) in heart failure (HF), which act primarily by inhibiting the renin-angiotensin-aldosterone system, has been thoroughly studied in different subgroups. This article reviews the most valid and recent evidence available concerning the use of ACEIs in HF due to left ventricular systolic dysfunction. The administration of ACEIs leads to statistically and clinically significant reductions in mortality (20 to 23%), risk of myocardial infarction (20 to 21%), hospitalization for heart failure (33%) and symptoms (as measured by NYHA classification). The existence of a class effect has been suggested for ACEIs. However, it has not been possible to demonstrate a significant effect on mortality in subgroup analysis for females or blacks. Higher doses of ACEIs are associated with a significant reduction in the combined endpoint of death or hospitalization for any reason and fewer hospitalizations for heart failure, but not in mortality risk or improvement as measured by NYHA class. All patients with HF should be prescribed an ACEI except in cases of contraindication or adverse reactions.