The renin-angiotensin system and treatment of heart failure

摘要: From the Heart and Hypertension Department, Research Institute of Cleveland Clinic Foundation, Cleveland, Ohio. Requests for reprints should be addressed to Dr. Fetnat M. Fouad-Taraii, 9500 Euclid Avenue, Ohio 44106. It has been years since converting enzyme inhibitors were introduced treatment congestive heart failure. Their effectiveness demonstrated in multiple reports that have shown improvement hemodynamic indexes as well clinical symptoms quality life [l-IO]. Moreover, this generally lasted months or years. Our experience respect is summarized Table I. We studied 14 patients with failure ischemic cardiomyopathic etiology, before after captopril therapy, obtained data at regular intervals over one year. These studies showed cardiac output stroke volume increased significantly association normalization pulmonary mean transit time, reduction plasma aldosterone, some both catecholamine levels rate. effects occurred within week sustained. Changes ejection fraction, however, minimal compared significant time (Figure 1) probably because fraction depends on left ventricular geometry addition loading conditions heart. Along these findings, severity (NYHA class) its other manifestations described treated by Dzau et al [7], Levine [8], others. Goldstein Pitt [l l] also that, placebo digoxin, resulted improved exercise duration, a 45 percent premature beats, frequency hospitalization. The mechanism which maintain still not understood. Several possibilities include: (1) persistent beneficial inhibition o’n afterload preload; (2) suppression aldosterone; (3) interference angiotensin II renal tubules; (4) direct effect accumulated I v21. Compared vasodilators, found more effective improving effort tolerance marked blood pressure increase [13]. findings indicated changes induced are only factors mediating long-term control during therapy. therapy was observed vasodilators but did develop when used similar suggesting additional considered. For example, humoral pa-