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ACE Inhibition Versus Angiotensin-II Antagonism in Heart Failure

Department of Medicine King George's Medical College Lucknow, Uttar Pradesh, India

For reprint information contact: Mahesh Chandra, MD Tel: 91 522 21 2103 or 39 8298 Fax: 91 522 26 6025 Department of Medicine, King George's Medical College, 11-A J.C. Bose Marg, Lucknow, Uttar Pradesh 226001, India.

Heart failure is becoming increasingly frequent. Once diagnosed, 5-year survival is less than 50% and a substantial percentage of patients (25% to 50%) die suddenly. Angiotensin-converting enzyme inhibitors are the only agents shown to reduce mortality in heart failure. All angiotensin-converting enzyme inhibitors appear to have similar clinical benefits in heart failure. Therapy should be started with a low dose and titrated up to the target dosage in major trials. Although angiotensin-I receptor antagonists provide more complete inhibition of angiotensin-II effects, they have not been found to be superior to long-acting angiotensin-converting enzyme inhibitors in reducing morbidity and mortality in heart failure. Therefore, in current clinical practice, angiotensin-II antagonists should be used as an alternative to angiotensin-converting enzyme inhibitors when the latter are not tolerated. The combined use of angiotensin-converting enzyme inhibitors and angiotensin-II antagonists is not currently recommended in the treatment of heart failure.

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