NEUROHORMONAL MECHANISMS AND THE ROLE OF ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS IN HEART-FAILURE

Clinical evidence accumulated over the past decade suggests that neuro hormonal mechanisms significantly influence the pathogenesis and event ual outcome of congestive heart failure (CI-. F). Pharmacologic modula tion of this neuroendocrine activity can, consequently, be expected to improve patient prognosis. Results of several recent clinical trials- the Studies of Left Ventricular Dysfunction (SOLVD), the second Vetera ns Administration Cooperative Vasodilator I-. eart Failure Trial (VI-. eFT-II), and the Cooperative North Scandinavian Enalapril Survival St udy (CONSENSUS)-provide substantial evidence that addition of the angi otensin-converting enzyme (ACE) inhibitor enalapril to conventional th erapeutic regimens can significantly reduce mortality and improve prog nosis in patients with all grades of heart failure. Moreover, data fro m all three trials confirm the involvement of neurohormonal systems in the development and progression of CI: F and suggest that the benefic ial effects of enalapril in heart failure may in part be due to the su ppression of this neurohormonal activity. It is now apparent that some form of neurohormonal activation is present early in the course of th e disease before the emergence of overt heart failure symptoms. On the basis of such findings, it would seem that early introduction of ther apy targeted at neurohormonal influences may well become a central com ponent of any future CHF treatment program.