Endothelial dysfunction in heart failure: Possibilities of therapy with angiotensin converting enzyme inhibitors

Most important result of the studies of pathogenesis of chronic heart failu re was discovery in the 70-80-ths of the previous century of peripheral vas cular spasm as a leading mechanism of maintenance of adequate perfusion pre ssure in vitally important organs under conditions of declining cardiac out put. However long standing elevated cardiac post- and then preload (arterio lar and venous vasoconstriction) with time transformed into the cause and d riving force of more profound damage of the cardiac muscle and of the heart failure progression. This discovery opened the new era in the management o f decompensated patients - era of peripheral vasodilators - and stimulated investigators to concentrate on sympathoadrenal and especially on renin-ang iotensin-aldosterone neurohumoral systems responsible for systemic vasocons triction. The search for more effective neurohumoral peripheral vasodilator s resulted in creation in the middle of the 70-ths of a novel class of drug s - angiotensin converting enzyme inhibitors.