Despite the successful therapeutic applications of angiotensin-converting enzyme (ACE) inhibitors to date, knowledge of how they work and guidelines for their use are still incomplete. On their role as monotherapy in congestive heart failure, we have scarce and conflicting data. Nor is there a clear answer to the question, when should an ACE inhibitor be started in a patient with heart failure?...

All patients with heart failure should have an echocardiogram to establish a diagnosis, both to aid treatment as well as for prognostic reasons. An audit of 100 case notes of patients admitted with acute left ventricular failure over a 12-month period found that 26 patients had not had an echocardiogram. Of the 74 who did have an echocardiogram 68 patients had reduced systolic function (mean ej...

A 43 year old man with inoperable aortic coarctation and severe hypertension requiring near maximal anti-hypertensive treatment was admitted in severe heart failure. After 2 weeks of treatment the heart failure and blood pressure were incompletely controlled and angiotensin converting enzyme (ACE) inhibitor was started. Serum creatinine was normal before starting the ACE inhibitor and on discha...

PURPOSE To examine the efficacy of ACE inhibitors for treatment of nondiabetic renal disease. DATA SOURCES 11 randomized, controlled trials comparing the efficacy of antihypertensive regimens including ACE inhibitors to the efficacy of regimens without ACE inhibitors in predominantly nondiabetic renal disease. STUDY SELECTION Studies were identified by searching the MEDLINE database for Eng...

The aim of this study was to clarify the differences between the angiotensin II type 1 (AT1) receptor antagonist and the angiotensin-converting enzyme (ACE) inhibitor on smooth muscle and nonmuscle myosin heavy chain isoforms in aortic smooth muscle cells of Wistar-Kyoto rats and spontaneously hypertensive rats. All 4 myosin heavy chain isoforms are heterogeneously expressed in the smooth muscl...

Background: Angiotensin converting enzyme (ACE) inhibitor toxicity is infrequently reported and seldom produces significant clinical effects. Only 15 previous cases of intentional ACE inhibitor overdoses among adults have been published. The most commonly observed clinical effect is hypotension, which is typically transitory and responsive to supportive measures and intravenous hydration. An ad...

Visceral angioedema is a rare complication of therapy with angiotensin-converting enzyme (ACE) inhibitors. Clinical presentation includes nausea, vomiting, abdominal pain and diarrhea. Early detection of this entity can prevent recurrent episodes and unnecessary invasive procedures, including surgery. This article describes a 46-year-old-woman who presented to the emergency department with abdo...

American College of Cardiology/American Heart Association class I recommendations for treating patients with heart failure (HF) and abnormal left ventricular ejection fraction are diuretics in patients with fluid retention, an angiotensin-converting enzyme (ACE) inhibitor unless contraindicated, a beta-blocker unless contraindicated, digoxin for the treatment of symptoms of HF, and withdrawal o...

The association between ACE (angiotensin-converting enzyme) gene insertion/deletion (I/D) polymorphism and mortality has been inconsistently observed in earlier studies in patients on maintenance hemodialysis. We hypothesized that the effect of ACE gene I/D polymorphism on mortality may be influenced by concurrent ACE inhibitor therapy in this population. In this prospective, multicenter cohort...