Emerging role of angiotensin-converting enzyme inhibitors in cardiac and vascular protection.

A ngiotensin-converting enzyme (ACE) inhibitors are commonly used drugs in the management of a variety of cardiovascular diseases. They are effective antihypertensive agents.1-3 Early studies have demonstrated reductions in mortality and symptoms of heart failure in patients with severe congestive heart failure.4 More recently, clinical trials have demonstrated reductions in mortality and in hospitalizations for heart failure when these agents were used in patients with moderate left ventricular dysfunction, with and without overt heart failure, further expanding the clinical value of these drugs in the management of patients with cardiac diseases. These benefits have been observed consistently in several trials,5-7 in patients with ischemic and nonischemic causes for the left ventricular dysfunction and with or without recent myocardial infarction. The reductions in progressive heart failure and mortality in these patients are at least partly related to a beneficial effect on left ventricular remodeling and reductions in left ventricular enlargement.8-10 Other potential beneficial effects of these agents, such as regression of left ventricular hypertrophy and retardation of the rate of loss of renal function in patients with diabetic nephropathy, have been brought into focus by recent trials and also by experimental studies that explore their mechanisms of action. A new and important potential role for ACE inhibitors is suggested by the recent trials in patients with low ejection fraction, which documented a significant reduction in major ischemic events such as myocardial infarction, unstable angina, and the need for coronary revascularization procedures. In addition, parallel epidemiological, genetic, and experimental studies suggest that the renin-angiotensin-aldosterone system may have a role in the development of coronary artery disease