The development of
angiotensin-converting enzyme inhibitors (
ACE inhibitors) has been one of the most remarkable stories in the treatment of
cardiovascular diseases.
Angiotensin converting enzyme inhibitors have several acute and sustained hemodynamic effects that are beneficial in the presence of left ventricular (
LV) dysfunction. They increase cardiac output and stroke volume and reduce systemic vascular resistance as well as pulmonary capillary wedge pressure. The hemodynamic benefits are associated with improvement in the signs and symptoms of
congestive heart failure (CHF) as well as decreased mortality, regardless of the severity of CHF. In patients with asymptomatic
LV dysfunction,
therapy with
ACE inhibitors prevented the development of CHF and reduced hospitalization and cardiovascular death. They also increase survival when administered early after an acute
myocardial infarction (MI). Most recently, ACE inhibition was associated with improved clinical outcomes in a broad spectrum of high-risk patients with preserved LV function. The mechanism of
ACE inhibitors benefits is multifactorial and includes prevention of progressive LV remodeling, prevention of
sudden death and arrhythmogenicity and structural stability of the atherosclerotic process. Evidence suggests that
ACE inhibitors are underutilized in patients with
cardiovascular diseases. Efforts should be directed to prescribe
ACE inhibitors to appropriate patients in target doses. It is reasonable to believe that
ACE inhibitors have a class effect in the management of
LV dysfunction with or without CHF and acute MI. Whether the same is true for
ACE inhibitors in the prevention of ischemic events is not known yet.