MILD HEART-FAILURE - WHY THE SWITCH TO ACE-INHIBITORS

Management of congestive heart failure in the past has focused on sodi um and fluid restriction, rest, and digitalis glycosides. Now, signifi cant new evidence justifies early and aggressive ACE inhibitor therapy in patients with asymptomatic or mildly symptomatic LV dysfunction. A CE inhibitors reduce the likelihood of symptomatic heart failure in as ymptomatic patients with reduced ejection fraction. Patients with redu ced LV function following acute MI who receive ACE inhibitors have a d ecreased risk of death, a lower probability of developing systematic h eart failure, and fewer MI recurrences. Hypotension and azotemia can b e avoided by reducing the concomitant dose of diuretics and carefully titrating the ACE inhibitor dosage to target levels.