ACE inhibitors improve heart failure

By DrRich

Dateline: 10/08/01

A study published in a recent issue of Circulation shows that patients with heart failure who were treated with the drug ramipril experienced significant beneficial effects.  Ramipril (marketed in the U.S. as Altace) is an ACE inhibitor - a drug prescribed most commonly for high blood pressure.  

When used in heart failure patients, ramipril resulted in a reduced incidence of left ventricular hypertrophy (LVH,) a condition in which the heart muscle thickens, and which has long been thought to produce several cardiovascular complications.  Ramipril resulted in an improvement in LVH even in patients who did not have high blood pressure in this study.

The same study also showed that patients whose LVH improved on ramipril ended up with a lower incidence of death, heart attack, stroke, and of worsening heart failure.  

To summarize, in patients with heart failure, ramipril resulted in:

• improvement in LVH
• a reduced risk of death, heart attack, stroke and heart failure

However, it should be noted that patients who were treated with placebo in this study also had a substantial improvement in LVH - the ramipril simply resulted in a higher degree of improvement.  The improvement in the placebo patients was attributed to the careful follow-up and management they received as participants in this study, and to the routine use of beta blockers.  

Thus, 

• while ramipril resulted in improvement over placebo, even the placebo patients had a remarkable improvement in LVH
• this study (accidently) points out the importance of careful follow-up and overall medical management in patients with heart failure
• patients with heart failure who are treated with a lower level of care than was provided by the investigators in this study may have less favorable results, even if they receive ramipril

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