Role of Race in the Pharmacotherapy of Heart Failure

2002 ◽  
Vol 36 (3) ◽  
pp. 471-478 ◽  
Author(s):  
James S Kalus ◽  
Jean M Nappi
Keyword(s):  
Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Ace Inhibitors ◽  
English Language ◽  
Systolic Heart Failure ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Medline Search ◽  
Black Patients ◽  
Β Blockers

OBJECTIVE: To review the literature assessing the differences in response to angiotensin-converting enzyme (ACE) inhibitors and β-blockers in black patients compared with the response in non-black patients in the management of systolic heart failure. DATA SOURCES: A MEDLINE search (January 1966–May 2001) was performed using heart failure, blacks, Negroid race, adrenergic β-antagonists, and angiotensin-converting enzyme inhibitors as key words. English-language articles were identified. Additional pertinent articles were identified from review of the references of these articles. STUDY SELECTION AND DATA EXTRACTION: All identified references were reviewed. All articles deemed relevant to the subject of this article were included. DATA SYNTHESIS: It has been suggested that the antihypertensive effect of ACE inhibitors and β-blockers may be less in black patients than in other racial groups. Retrospective reanalyses of major heart failure trials have suggested that black patients may not realize a significant benefit in morbidity or mortality when heart failure is managed with ACE inhibitors or β-blockers. It has also been suggested that black patients may respond more favorably than non-black patients to the combination of hydralazine and isosorbide dinitrate. CONCLUSIONS: Published reanalyses of ACE inhibitor and β-blocker trials in heart failure provide weak data to support a lack of benefit in black patients. The published literature on this topic is limited by its retrospective nature. Firm conclusions regarding the influence of race on effectiveness of ACE inhibitors and β-blockers cannot be made until prospective trials, with planned analysis of the effect of race, have been performed.

Endocrinologic Warfare: The Role of Angiotensin-Converting Enzyme Inhibitors in Congestive Heart Failure

1990 ◽  
Vol 3 (5) ◽  
pp. 318-331
Author(s):  
Mark A. Munger ◽  
Stephanie F. Gardner ◽  
Robert C. Jarvis
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Ace Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Vasodilator Therapy ◽  
The Future

The angiotensin-converting enzyme (ACE) inhibitors represent the gold standard of vasodilator therapy for congestive heart failure through blunting of the endocrinologic manifestations of heart failure. The future role of these agents may be in the asymptomatic and mild stages of heart failure. ACE inhibitors have been shown to decrease morbidity and mortality with the natural history of this disease being altered. The future will bring many new ACE inhibitors to market, with the challenge for physicians and pharmacists to understand the important distinctions of each specific agent. © 1990 by W.B. Saunders Company.

Abstract 19588: Angiotensin Converting Enzyme Inhibitors and Mortality Benefit in Systolic Heart Failure Patients With Glomerular Filtration Rate <30 ml/min/1.73 m2

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Chakradhari Inampudi ◽  
Vladimir Cotarlan
Keyword(s):  
Heart Failure ◽  
Glomerular Filtration Rate ◽  
Angiotensin Converting Enzyme ◽  
Filtration Rate ◽  
Index Date ◽  
Enzyme Inhibitors ◽  
Systolic Heart Failure ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors

Introduction: Randomized controlled trials have shown beneficial effect of Angiotensin converting enzyme inhibitors (ACEI) in reducing mortality in patients with systolic heart failure (HF) and chronic kidney disease (CKD) with glomerular filtration rate (GFR) between 30-59 ml/min/1.73m2 but weak evidence exists in patients with GFR < 30 Hypothesis: We hypothesize that ACEI use is associated with lower mortality in CKD patients with GFR < 30. Methods: Using electronic medical records, we identified 2578 patients with advanced CKD defined as GFR < 30 but not on dialysis. We required a GFR < 30 on two occasions over a 60 day period to insure stability of CKD. Clinical outcomes were reviewed following the index date which was the date of first GFR < 30. Results: Of 2,578 patients (mean age 66+/-15, 61% males) with advanced CKD (GFR<30), 1,064 (41%) have been treated with an ACEI while 1,514 (59%) never received an ACEI. Kaplan Meyer Survival showed reduced mortality in the group of patients treated with an ACEI compared to those never treated with an ACEI despite more comorbidities present in the former group (mean survival 3.9 vs 4.8 years, p<0.001, Fig 1). Of the patients treated with an ACEI, 232 (22%) continued the ACEI till the end of follow up while 832 (78%) patients discontinued the drug: 93 (9%) prior to index date and 739 (69%) after index date. Survival was significantly better in patients who continued the ACEI than those who discontinued the drug late (after the index date) and those who discontinued early (prior to index date) than in those never treated with an ACEI (Fig 2). Conclusion: Treatment with ACEIs is associated with improved survival in CKD patients with GFR < 30ml/min/1.73m2

Angiotensin-Converting Enzyme Inhibitors in Congestive Heart Failure: Practice versus Guidelines

2002 ◽  
Vol 18 (5) ◽  
pp. 229-240 ◽  
Author(s):  
Nathalie Thilly ◽  
Serge Briançon ◽  
Yves Juilliere ◽  
Edith Dufay ◽  
Faiez Zannad
Keyword(s):  
Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Ace Inhibitors ◽  
Ace Inhibitor ◽  
Systolic Heart Failure ◽  
Converting Enzyme ◽  
International Guidelines ◽  
Factors Associated ◽  
Digitalis Glycoside ◽  
Age Over 60

Background: Angiotensin-converting enzyme (ACE) inhibitors decrease morbidity and mortality in patients with systolic heart failure. In the practice of cardiology, ACE inhibitors are insufficiently prescribed by cardiologists. Objective: To measure the deviation between observed practice and clinical practice guidelines (CPGs), and to identify factors contributing to the deviation. Methods: CPGs have been developed from available international guidelines via a procedure involving a consensus group. A practice survey was conducted on 208 patients less than 75 years old hospitalized in public hospital cardiology units. Factors associated with nonadherence to CPGs were identified among characteristics of patients, practitioners, and cardiology units in logistic regression models. Results: In patients for whom the prescription of ACE inhibitors was not contraindicated, ACE inhibitor therapy was not initiated in 14%, and the CPR dosages were not attained in 51.2% of the cases. Factors associated with treatment not being initiated were age over 60 years (p = 0.001), increased ejection fraction (p = 0.005), and treatment with diuretics (p = 0.001) and digitalis glycosides (p = 0.008) at hospital admission. Factors associated with prescription of subtarget doses were age over 60 years (p = 0.024), low serum potassium concentration (p = 0.014), and absence of digitalis glycoside treatment (p = 0.039) at the start of ACE inhibitor administration. Conclusions: Our work has shown that cardiologists tend to adapt their prescription of ACE inhibitors to clinical situations that are not considered relevant in international guidelines. The implementation of CPGs in cardiology units should target adequate information about these situations.

Current Perspective on the Use of Angiotensin-Converting Enzyme Inhibitors in the Management of Coronary (Atherosclerotic) Artery Disease

1997 ◽  
Vol 31 (12) ◽  
pp. 1499-1506 ◽  
Author(s):  
Judy WM Cheng ◽  
Mimi N Ngo
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Ace Inhibitors ◽  
English Language ◽  
Data Extraction ◽  
Renin Angiotensin System ◽  
Therapeutic Monitoring ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Beneficial Effects

OBJECTIVE: To review the pathophysiology of atherosclerosis, the role of the renin—angiotensin system in atherogenesis, and studies supporting the potential beneficial effects of angiotensin-converting enzyme (ACE) inhibitors in reducing cardiovascular events with long-term use. BACKGROUND: Through its action in converting angiotensin I to angiotensin II and by degrading bradykinin, local tissue ACE exerts many effects that can contribute to the development of atherosclerosis. Therefore, the use of ACE inhibitors can possibly result in antiatherogenic effects. Possible mechanisms for antiatherogenic effects of ACE inhibitors include: (1) reduction of blood pressure; (2) antiproliferative and antimigratory effects on vascular smooth muscle cells, neutrophils, and monocytes; (3) restoration of endothelial function; (4) stabilization of fatty plaque by preventing vasoconstriction; (5) antiplatelet effects; and (6) enhancement of endogenous fibrinolysis. DATA SOURCES: English-language clinical studies, abstracts, and review articles pertaining to the use of ACE inhibitors and atherosclerosis. STUDY SELECTION AND DATA EXTRACTION: Relevant human studies examining the role of ACE inhibitors and atherosclerosis. DATA SYNTHESIS: Studies evaluating the possible beneficial effects of ACE inhibitors in the development of atherosclerosis are reviewed and critiqued. Design of ongoing studies with clinical and surrogate end points are discussed. CONCLUSIONS: Based on current published studies, recommendations are made regarding the use of ACE inhibitors in atherosclerosis. Therapeutic monitoring parameters for efficacy and adverse effects are also reviewed.

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