Chapter

Angiotensin converting enzyme inhibitors and vasodilators

Iain Squire and Andrew L. Clark

in Oxford Textbook of Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199577729
Published online July 2011 | e-ISBN: 9780199697809 | DOI: http://dx.doi.org/10.1093/med/9780199577729.003.0037

Series: Oxford Textbooks

Angiotensin converting enzyme inhibitors and vasodilators

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Heart failure (HF) is a complex syndrome, characterized byneurohumoral activation. That increased activation of the renin–angiotensin–aldosterone system (RAAS) plays a central role in thepathophysiology of chronic HF, has been recognized for many years. However, until the latter part of the 20th century, the pharmacologicalmanagement of chronic HF was limited to correction of fluid and electrolyte disturbances (diuretics) and augmentationof myocardial contractility (cardiac glycosides).The situation is very different now; physicians caring for patientswith HF have at their disposal an armamentarium of powerfulpharmacological therapies, encompassing angiotensin convertingenzyme (ACE) inhibitors, angiotensin receptor antagonists, aldosteronereceptor antagonists, and β -receptor blockers, in addition toour old friends diuretics and digoxin. To a greater or lesser extent,the newer agents act to inhibit activity of the RAAS, emphasizingthe crucial role of this system in the HF syndrome. Among the agents with proven efficacy in the management of HF, ACE inhibitorshave the most extensive evidence base, and, in head-to headcomparisons with alternative RAAS inhibitors, remain unsurpassed in terms of clinical benefit. This chapter considers briefly the development and pharmacologyof ACE inhibitors, their physiological actions, and the evidencebase for their prescription to patients with HF. It also discusses the side effect profile of ACE inhibitors.

Chapter.  6281 words.  Illustrated.

Subjects: Cardiovascular Medicine

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