Why ace inhibitors in heart failure

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Apply market research to generate audience insights. Measure content performance. Develop and improve products. List of Partners vendors. Using an angiotensin-converting enzyme ACE inhibitor drug is an important part of treating heart failure. In people with this condition, ACE inhibitors have been shown to improve symptoms, reduce the need for hospitalization, and even prolong survival.

If you have been diagnosed with heart failure, you will likely be treated with an ACE inhibitor unless there are good reasons not to do so. The RAAS is a chain of enzymes that work together to regulate blood pressure and the concentration of sodium in the blood.

When blood flow to the kidneys is reduced—a common occurrence in heart failure, in which the heart isn't able to pump enough blood to meet the body's needs—an enzyme called renin is released into the bloodstream. Renin causes another enzyme, angiotensin I, to increase. Angiotensin II increases blood pressure by causing blood vessels to constrict.

Angiotensin II also stimulates the release of the hormone aldosterone, which causes the body to retain sodium. This makes the body retain more water and increases blood volume. The RAAS tends to work overtime in people with heart failure. By increasing blood pressure and blood volume, it forces the heart to work harder than it should.

ACE inhibitors work by blocking the formation of angiotensin II. In people with heart failure, this lowers blood pressure and reduces sodium retention. In this way, ACE inhibitors relieve the stress on the heart and allow the weakened heart muscle to pump more efficiently.

ACE inhibitors are one of the first-line treatments for hypertension high blood pressure , and they have been shown to improve outcomes in people who have had heart attacks. In addition, they can help prevent kidney damage in people with diabetes.

Several major clinical trials have looked at the use of ACE inhibitors in heart failure treatment. They have shown that ACE inhibitors significantly reduce the need for hospitalization, improve survival, and lower the risk of heart attacks.

Symptoms of heart failure such as dyspnea shortness of breath and fatigue also improve. Current guidelines from the American College of Cardiology and the American Heart Association strongly recommend that ACE inhibitors be given to anyone who has heart failure and, in addition, to anyone who has a reduced left ventricular ejection fraction less than 0.

Several ACE inhibitors are on the market, and it is generally thought that they are equally beneficial in the treatment of heart failure. Commonly used ACE inhibitors include:. When first prescribed, ACE inhibitors usually are started at a low dose, and the dosage is gradually increased to the target dosage. Gradually increasing the dosage helps prevent adverse effects.

If the higher doses are not tolerated well, treatment is usually continued at a lower, better-tolerated dose. Most experts believe that lower doses of ACE inhibitors are nearly as effective as higher doses, but higher doses are preferred because they have been formally tested in clinical studies. Some studies suggest that ACE inhibitors may be less effective in Black people than in Whites, but the evidence is conflicting. For Black people with certain types of heart failure plus hypertension, other medications may be recommended instead of ACE inhibitors.

Clinical studies have not proven the same magnitude of benefit with ACE inhibitors in females as has been demonstrated in males. However, the preponderance of evidence still favors using ACE inhibitors in all females with heart failure.

While ACE inhibitors are usually tolerated quite well, certain side effects may occur, including:. People who are pregnant, breastfeeding, or planning to become pregnant should not take ACE inhibitors, because the drugs can cause serious problems in the baby. Complications can include problems with kidney function, skull formation, and even death. People should stop taking ACE inhibitors as soon as they learn they are pregnant.

Some other reasons people should not take ACE inhibitors include:. In addition, people taking an ACE inhibitor should avoid using nonsteroidal anti-inflammatory drugs NSAIDs , such as Advil ibuprofen or Aleve naproxen , as these pain relievers may make the ACE inhibitor less effective and increase the risk of kidney damage.

The renin-angiotensin-aldosterone system plays an important role in the development of congestive heart failure CHF. In patients with chronic heart failure, angiotensin-converting enzyme ACE inhibitors, such as captopril, enalapril, and quinapril, have been shown to improve hemodynamics, reduce symptoms of fatigue and dyspnea, increase exercise capacity, correct hyponatremia, reduce diuretic requirements and ventricular arrhythmias, and conserve potassium and magnesium. ACE inhibitors reduce circulating levels of angiotensin II and aldosterone and may reduce plasma norepinephrine and vasopressin levels.

They are equally effective in patients with mild to moderate heart failure and in patients with severe cardiac impairment. ACE inhibitors are at least as beneficial as digitalis in patients with mild heart failure, and they may even be considered as first-line therapy.