The data herein presented provides persuasive evidence that in addition to
diuretics, and probably digitalis (since all studies have included subjects taking this
drug) patients with
congestive heart failure should also be placed on a
vasodilator regimen to slow the progression of the syndrome and to reduce its mortality. Firm recommendations for the choice of
drug and the selection of patients likely to benefit from this treatment must await the results of further studies. At present,
ACE inhibitors are preferred because they are usually better tolerated than conventional
vasodilators and are clinically more effective. In regard to the question of when to begin
vasodilator it is noteworthy that neurohormonal activation may occur early in the course of the disease, even before symptoms appear. If so, perhaps
vasodilators should be initiated even in the asymptomatic stage of
left ventricular dysfunction to prevent the progressive dilatation and deterioration that lead to clinical
heart failure. The just published study of the efficacy of
captopril in preventing the progression of left ventricular dilatation in patients with a recent anterior, transmural
myocardial infarction supports this view. Further, ongoing studies, will help place these issues in their proper perspective.