Natural history of patients with congestive heart failure. Potential role of converting enzyme inhibitors in improving survival.

To alter the natural history of congestive heart failure and change the poor prognosis for patients with this condition will require new insights into its pathogenesis as well as the development of strategies to alter the neurohumeral and serum electrolyte abnormalities associated with congestive heart failure, which are often exaggerated by current therapeutic approaches. Although improvement in hemodynamics and exercise tolerance in patients with congestive heart failure remains important, the emphasis of therapeutic goals should be shifted to prevent further cardiac deterioration and to prevent sudden cardiac death. The use of converting enzyme inhibitors holds promise for a beneficial effect on the altered hemodynamic, electrolyte, and neurohumeral abnormalities associated with congestive heart failure. If further prospective randomized trials confirm the beneficial effects of these agents in reducing the mortality rate among patients with congestive heart failure, it is likely that these benefits will have stemmed from their effects on neurohumeral factors and serum electrolyte abnormalities rather than from their effects on hemodynamics.