Role of Angiotensin Converting Enzyme (ACE) Inhibitors in the Management of Heart Failure

In this article, we will discuss the Role of Angiotensin Converting Enzyme (ACE) Inhibitors in the Management of Heart Failure. So, let’s get started.

Angiotensin Converting Enzyme (ACE) Inhibitors

Angiotensin-converting enzyme
inhibitors are potent vasodilators
(dilatation of both venous and arterial
bed), act by antagonising the action
of stimulated renin-angiotensin
system in CHF, therefore, all patients
with heart failure due to LV systolic
dysfunction (EF <40%) should receive
an ACE inhibitor.

Dose: Treatment with ACE should
be initiated at very low doses because
of risk of first dose hypotension
followed by gradual increments in dose. The starting dose, i.e. captopril 6.25 mg, enalapril 2.5 mg, lisinopril 2.5 mg should be given twice or thrice a day for 3-5 days and then dose may be increased if needed. Renal function and potassium should be assessed during the therapy.

The side-effects of ACE inhibitors
include hypotension, worsening renal
function and hyperkalaemia, intractable cough and angioedema. Less common side-effects are rash, mouth ulcers, taste disturbance and blood dyscrasias.

Contraindication: Intrinsic renal disease, bilateral renal artery stenosis
and systemic hypotension are their
contraindications. In case of cough and
angioedema due to ACE, another class
of drug, angiotensin receptor blockers
(losartan, irbesartan, candesartan)
may be used whose effects are similar
to ACE.


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