INTERRUPTION OF THE PROGRESSION OF HEART-FAILURE - ARE ACE-INHIBITORSTHE SOLUTION

Our options for the medical management of heart failure are aimed at p reventing the development of the condition, relieving symptoms, modify ing the underlying pathophysiology, and delaying or preventing disease progression. The principal symptoms of heart failure are edema, dyspn ea and fatigue. Diuretics are effective in relieving edema, and dyspne a resulting from pulmonary edema. Once pulmonary edema has been treate d relatively few agents are effective against residual exercise-induce d dyspnea, possibly because of the numerous possible causes of this sy mptom. Angiotensin-converting enzyme (ACE) inhibitors have, however, b een shown to improve dyspnoea by mechanisms that are not related to he modynamic actions. These agents also improve skeletal muscle blood flo w and function, thereby relieving fatigue in heart failure patients. T reatment strategies aimed at modifying the underlying pathophysiology or preventing disease progression have, with the exception of the ACE inhibitors, met with limited success. Large-scale trials have shown, h owever, that ACE inhibitors improve survival in patients with moderate or severe heart failure, and prevent the development of heart failure in asymptomatic patients. These agents, therefore, represent an impor tant advance in the management of heart failure, and it is anticipated that new insights into their optimal use will follow as the mechanism s by which they exert their beneficial effects become clear.