Download ACE Inhibition: 25 Years of Progress From Hypertension and Heart

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ACE inhibition - a 25 year success story in therapeutics:
from hypertension and heart failure to a preventive
approach in high risk patients
Professor Norman Sharpe, University of Auckland, New Zealand
Coronary heart disease death rates have been declining in most
Western countries during the past 2-3 decades but are increasing in
many other countries. The reasons for the decline in Western
countries relate to reduced disease incidence as a result of
population primary prevention and improved disease management
and secondary prevention due to coronary intervention and drug
In terms of coronary disease progression from the earliest stage of
risk factors to end stage heart disease there are opportunities for
effective intervention at every stage. ACE inhibitors have various
different mechanisms of cardiac and vascular protection and have
been shown effective in hypertension, chronic heart failure, postMI LV
dysfunction and heart failure and most recently in high risk patients
with atherosclerosis and particularly in diabetics.
The numerous cardiovascular benefits of ACE inhibition are
established on an extensive evidence base allowing clear
recommendations for such treatment in a wide range of patients with
cardiovascular disease. In clinical practice, the same patient selection
criteria and treatment regimens should be observed as in the clinical
trials to maximize patient benefits and avoid undue harms. It should
not be assumed that all drugs within a class are interchangeable. For
most cardiovascular indications a class effect with ACE inhibition is
likely but for atherosclerosis and high risk patients the considerable
benefits of treatment have been best exemplified with ramipril (HOPE
The challenge in translating clinical trial evidence into practice is to
implement modern evidence-based guidelines as widely and
accurately as possible to ensure that the potential for improved
patient outcomes from such therapy as ACE inhibition is accessible
and fully realized.