Therapeutic implications of escape from angiotensin-converting enzyme inhibition in patients with chronic heart failure

被引：38

作者：

Ennezat P.V. ^{[1
]}

Berlowitz M. ^{[1
]}

Sonnenblick E.H. ^{[1
]}

Le Jemtel T.H. ^{[1
]}

机构：

[1] Albert Einstein College of Medicine, Division of Cardiology, Forchheimer Building, Bronx, NY 10461

来源：

Current Cardiology Reports | 2000年 / 2卷 / 3期

关键词：

Chronic Heart Failure; Captopril; Enalapril; Losartan; Pressure Response;

D O I：

10.1007/s11886-000-0077-3

中图分类号：

学科分类号：

摘要：

The level of inhibition of the angiotensin-converting enzyme (ACE) provided by standard doses of ACE inhibitors may only be partial during long-term treatment in patients with severe chronic heart failure (CHF). Partial ACE inhibition with time is often referred to as escape from ACE inhibition and labeled ACE escape. Several lines of evidence suggest that ACE escape occurs in patients with severe CHF. Plasma levels of angiotensin II rise above initial values during long-term ACE inhibition, and the effects of ACE inhibitors on cardiac remodeling and lowering of sympathetic nervous system activity attenuate after 1 year of treatment. Moreover, angiotensin II type I receptor blockade (ARB) produces clinical and hemodynamic benefits in patients with CHF who are already receiving ACE inhibitors. The therapeutic implications of ACE escape include evaluation of higherthan- standard doses of ACE inhibitors and routine addition of ARB to ACE inhibition in patients with severe CHF. Data are reviewed to demonstrate that ACE escape reflects inadequate ACE dosage rather than a decrease in ACE inhibition occurring with time. Copyright © 2000 by Current Science Inc.

引用

页码：258 / 262

页数：4

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