Congestive heart failure ACE inhibitors

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Editor(s)-In-Chief: James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [1] and C. Michael Gibson, M.S., M.D. [2], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [3];Seyedmahdi Pahlavani, M.D. [4] Edzel Lorraine Co, DMD, MD[5]

Overview

The Collaborative Group on ACE Inhibitor Trials demonstrated significant reduction in total mortality and hospitalization with the administration of ACEIs that was consistent among wide range of patients.[1]

ACE Inhibitors

Indications for ACE Inhibitors Use

1. The left ventricular ejection fraction (LVEF) is ≤ 40%

or

2. There is a prior history of myocardial infarction (MI)

Background

Dosing

  • ACE-I or ARB therapy should be initiated at low dosage such as 12.5 mg tid of captopril, 2.5 mg bid of enalapril[2][3], or 2.5 mg daily lisinopril.
  • Every 4 to 6 weeks the dose is gradually uptitrated, as tolerated, toward target dosages of 20-40 mg daily for lisinopril, 10-20 mg twice daily for enalapril maleate, and 50-100 mg three times a day for captopril, or to the maximum tolerated dosage.
  • ACE inhibitors are rarely adequate for the treatment of congestion without the use of diuretics.

Complications

2022 AHA/ ACC/ HFSA Heart Failure Guideline/ 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America ((DO NOT EDIT) [6][7][8]

Renin-Angiotensin System Inhibition With ACEi or ARB or ARNi

Class I
"1. In patients with HFrEF and NYHA class II to III symptoms, the use of ARNi is recommended to reduce morbidity and mortality. [9][10][11][12][13](Level of Evidence: A) "
"2. In patients with previous or current symptoms of chronic HFrEF, the use of ACEi is beneficial to reduce morbidity and mortality when the use of ARNi is not feasible.[3][2][14][15][16][17][1][18] (Level of Evidence: A) "
"3. In patients with previous or current symptoms of chronic HFrEF who are intolerant to ACEi because of cough or angioedema and when the use of ARNi is not feasible, the use of ARB is recommended to reduce morbidity and mortality. [19][20][21][22][23] (Level of Evidence: A) "
"5. In patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACEi or ARB, replacement by an ARNi is recommended to further reduce morbidity and mortality. [9][10][11][12][13](Level of Evidence: B-R) "
Class Value Statement: High Value
"4. In patients with previous or current symptoms of chronic HFrEF, in whom ARNi is not feasible, treatment with an ACEi or ARB provides high economic value. [24][25][26][27][28][29][30](Level of Evidence: A) "
"6. In patients with chronic symptomatic HFrEF, treatment with an ARNi instead of an ACEi provides high economic value. [31][32][33][34] (Level of Evidence: A) "
Class III (Harm)
"7. ARNi should not be administered concomitantly with ACEi or within 36 hours of the last dose of an ACEi. [35][36] (Level of Evidence: B-R) "
"8. ARNi should not be administered to patients with any history of angioedema.[37][38][39][40] (Level of Evidence: C-LD) "
"9. ACEi should not be administered to patients with any history of angioedema. [41][42][43][44] (Level of Evidence: C-LD) "

Vote on and Suggest Revisions to the Current Guidelines

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References

  1. ↑ 1.0 1.1 Garg R, Yusuf S (1995). "Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials". JAMA : the Journal of the American Medical Association. 273 (18): 1450–6. PMID 7654275. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  2. ↑ 2.0 2.1 "Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators". The New England Journal of Medicine. 325 (5): 293–302. 1991. doi:10.1056/NEJM199108013250501. PMID 2057034. Retrieved 2012-04-03. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 "Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). The CONSENSUS Trial Study Group". The New England Journal of Medicine. 316 (23): 1429–35. 1987. doi:10.1056/NEJM198706043162301. PMID 2883575. Retrieved 2012-04-03. Unknown parameter |month= ignored (help)
  4. ↑ Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, Yusuf S, Pocock S (2003). "Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme". Lancet. 362 (9386): 759–66. PMID 13678868. Retrieved 2012-04-03. Unknown parameter |month= ignored (help)
  5. ↑ Young JB, Dunlap ME, Pfeffer MA, Probstfield JL, Cohen-Solal A, Dietz R, Granger CB, Hradec J, Kuch J, McKelvie RS, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, Held P, Solomon SD, Yusuf S, Swedberg K (2004). "Mortality and morbidity reduction with Candesartan in patients with chronic heart failure and left ventricular systolic dysfunction: results of the CHARM low-left ventricular ejection fraction trials". Circulation. 110 (17): 2618–26. doi:10.1161/01.CIR.0000146819.43235.A9. PMID 15492298. Retrieved 2012-04-03. Unknown parameter |month= ignored (help)
  6. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  7. ↑ Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE; et al. (2013). "2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
  8. ↑ 8.0 8.1 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016.DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
  9. ↑ 9.0 9.1 McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR; et al. (2014). "Angiotensin-neprilysin inhibition versus enalapril in heart failure". N Engl J Med. 371 (11): 993–1004. doi:10.1056/NEJMoa1409077. PMID 25176015. Review in: Evid Based Med. 2015 Apr;20(2):61 Review in: Ann Intern Med. 2015 Feb 17;162(4):JC2
  10. ↑ 10.0 10.1 Wachter R, Senni M, Belohlavek J, Straburzynska-Migaj E, Witte KK, Kobalava Z; et al. (2019). "Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study". Eur J Heart Fail. 21 (8): 998–1007. doi:10.1002/ejhf.1498. PMID 31134724.
  11. ↑ 11.0 11.1 Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K; et al. (2019). "Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure". N Engl J Med. 380 (6): 539–548. doi:10.1056/NEJMoa1812851. PMID 30415601.
  12. ↑ 12.0 12.1 Desai AS, Solomon SD, Shah AM, Claggett BL, Fang JC, Izzo J; et al. (2019). "Effect of Sacubitril-Valsartan vs Enalapril on Aortic Stiffness in Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial". JAMA. 322 (11): 1077–1084. doi:10.1001/jama.2019.12843. PMC 6749534 Check |pmc= value (help). PMID 31475296.
  13. ↑ 13.0 13.1 Wang Y, Zhou R, Lu C, Chen Q, Xu T, Li D (2019). "Effects of the Angiotensin-Receptor Neprilysin Inhibitor on Cardiac Reverse Remodeling: Meta-Analysis". J Am Heart Assoc. 8 (13): e012272. doi:10.1161/JAHA.119.012272. PMC 6662364 Check |pmc= value (help). PMID 31240976.
  14. ↑ Packer M, Poole-Wilson PA, Armstrong PW, Cleland JG, Horowitz JD, Massie BM; et al. (1999). "Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group". Circulation. 100 (23): 2312–8. doi:10.1161/01.cir.100.23.2312. PMID 10587334.
  15. ↑ Pfeffer MA, Braunwald E, Moyé LA, Basta L, Brown EJ, Cuddy TE; et al. (1992). "Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators". N Engl J Med. 327 (10): 669–77. doi:10.1056/NEJM199209033271001. PMID 1386652.
  16. ↑ "Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators". Lancet. 342 (8875): 821–8. 1993. PMID 8104270.
  17. ↑ Køber L, Torp-Pedersen C, Carlsen JE, Bagger H, Eliasen P, Lyngborg K; et al. (1995). "A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group". N Engl J Med. 333 (25): 1670–6. doi:10.1056/NEJM199512213332503. PMID 7477219.
  18. ↑ Woodard-Grice AV, Lucisano AC, Byrd JB, Stone ER, Simmons WH, Brown NJ (2010). "Sex-dependent and race-dependent association of XPNPEP2 C-2399A polymorphism with angiotensin-converting enzyme inhibitor-associated angioedema". Pharmacogenet Genomics. 20 (9): 532–6. doi:10.1097/FPC.0b013e32833d3acb. PMC 2945219. PMID 20625347.
  19. ↑ Cohn JN, Tognoni G, Valsartan Heart Failure Trial Investigators (2001). "A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure". N Engl J Med. 345 (23): 1667–75. doi:10.1056/NEJMoa010713. PMID 11759645.
  20. ↑ Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Køber L, Maggioni AP; et al. (2003). "Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both". N Engl J Med. 349 (20): 1893–906. doi:10.1056/NEJMoa032292. PMID 14610160. Review in: ACP J Club. 2004 Jul-Aug;141(1):3
  21. ↑ Konstam MA, Neaton JD, Dickstein K, Drexler H, Komajda M, Martinez FA; et al. (2009). "Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial". Lancet. 374 (9704): 1840–8. doi:10.1016/S0140-6736(09)61913-9. PMID 19922995. Review in: Evid Based Med. 2010 Apr;15(2):51-2
  22. ↑ Dominiak M (2008). "[Commentary to the article: ONTARGET Investigators, Yusuf S, Teo KK, Pogue J et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358: 1547-59]". Kardiol Pol. 66 (6): 705–6, discussion 707. PMID 18700309.
  23. ↑ Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) Investigators. Yusuf S, Teo K, Anderson C, Pogue J, Dyal L; et al. (2008). "Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial". Lancet. 372 (9644): 1174–83. doi:10.1016/S0140-6736(08)61242-8. PMID 18757085. Review in: Ann Intern Med. 2009 Feb 17;150(4):JC2-6
  24. ↑ Banka G, Heidenreich PA, Fonarow GC (2013). "Incremental cost-effectiveness of guideline-directed medical therapies for heart failure". J Am Coll Cardiol. 61 (13): 1440–6. doi:10.1016/j.jacc.2012.12.022. PMID 23433562.
  25. ↑ Dasbach EJ, Rich MW, Segal R, Gerth WC, Carides GW, Cook JR; et al. (1999). "The cost-effectiveness of losartan versus captopril in patients with symptomatic heart failure". Cardiology. 91 (3): 189–94. doi:10.1159/000006908. PMID 10516413.
  26. ↑ Glick H, Cook J, Kinosian B, Pitt B, Bourassa MG, Pouleur H; et al. (1995). "Costs and effects of enalapril therapy in patients with symptomatic heart failure: an economic analysis of the Studies of Left Ventricular Dysfunction (SOLVD) Treatment Trial". J Card Fail. 1 (5): 371–80. doi:10.1016/s1071-9164(05)80006-5. PMID 12836712.
  27. ↑ Paul SD, Kuntz KM, Eagle KA, Weinstein MC (1994). "Costs and effectiveness of angiotensin converting enzyme inhibition in patients with congestive heart failure". Arch Intern Med. 154 (10): 1143–9. PMID 8185426.
  28. ↑ Reed SD, Friedman JY, Velazquez EJ, Gnanasakthy A, Califf RM, Schulman KA (2004). "Multinational economic evaluation of valsartan in patients with chronic heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT)". Am Heart J. 148 (1): 122–8. doi:10.1016/j.ahj.2003.12.040. PMID 15215801.
  29. ↑ Shekelle P, Morton S, Atkinson S, Suttorp M, Tu W, Heidenreich P; et al. (2003). "Pharmacologic management of heart failure and left ventricular systolic dysfunction: effect in female, black, and diabetic patients, and cost-effectiveness". Evid Rep Technol Assess (Summ) (82): 1–6. PMC 4781559. PMID 14571595.
  30. ↑ Tsevat J, Duke D, Goldman L, Pfeffer MA, Lamas GA, Soukup JR; et al. (1995). "Cost-effectiveness of captopril therapy after myocardial infarction". J Am Coll Cardiol. 26 (4): 914–9. doi:10.1016/0735-1097(95)00284-1. PMID 7560617.
  31. ↑ Gaziano TA, Fonarow GC, Claggett B, Chan WW, Deschaseaux-Voinet C, Turner SJ; et al. (2016). "Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With Heart Failure and Reduced Ejection Fraction". JAMA Cardiol. 1 (6): 666–72. doi:10.1001/jamacardio.2016.1747. PMID 27438344.
  32. ↑ Gaziano TA, Fonarow GC, Velazquez EJ, Morrow DA, Braunwald E, Solomon SD (2020). "Cost-effectiveness of Sacubitril-Valsartan in Hospitalized Patients Who Have Heart Failure With Reduced Ejection Fraction". JAMA Cardiol. 5 (11): 1236–1244. doi:10.1001/jamacardio.2020.2822. PMC 7675099 Check |pmc= value (help). PMID 32785628 Check |pmid= value (help).
  33. ↑ King JB, Shah RU, Bress AP, Nelson RE, Bellows BK (2016). "Cost-Effectiveness of Sacubitril-Valsartan Combination Therapy Compared With Enalapril for the Treatment of Heart Failure With Reduced Ejection Fraction". JACC Heart Fail. 4 (5): 392–402. doi:10.1016/j.jchf.2016.02.007. PMID 27039128.
  34. ↑ Sandhu AT, Ollendorf DA, Chapman RH, Pearson SD, Heidenreich PA (2016). "Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With Reduced Ejection Fraction". Ann Intern Med. 165 (10): 681–689. doi:10.7326/M16-0057. PMID 27571284.
  35. ↑ Packer M, Califf RM, Konstam MA, Krum H, McMurray JJ, Rouleau JL; et al. (2002). "Comparison of omapatrilat and enalapril in patients with chronic heart failure: the Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events (OVERTURE)". Circulation. 106 (8): 920–6. doi:10.1161/01.cir.0000029801.86489.50. PMID 12186794.
  36. ↑ Kostis JB, Packer M, Black HR, Schmieder R, Henry D, Levy E (2004). "Omapatrilat and enalapril in patients with hypertension: the Omapatrilat Cardiovascular Treatment vs. Enalapril (OCTAVE) trial". Am J Hypertens. 17 (2): 103–11. doi:10.1016/j.amjhyper.2003.09.014. PMID 14751650.
  37. ↑ Vardeny O, Miller R, Solomon SD (2014). "Combined neprilysin and renin-angiotensin system inhibition for the treatment of heart failure". JACC Heart Fail. 2 (6): 663–70. doi:10.1016/j.jchf.2014.09.001. PMID 25306450.
  38. ↑ Messerli FH, Nussberger J (2000). "Vasopeptidase inhibition and angio-oedema". Lancet. 356 (9230): 608–9. doi:10.1016/S0140-6736(00)02596-4. PMID 10968427.
  39. ↑ Braunwald E (2015). "The path to an angiotensin receptor antagonist-neprilysin inhibitor in the treatment of heart failure". J Am Coll Cardiol. 65 (10): 1029–41. doi:10.1016/j.jacc.2015.01.033. PMID 25766951.
  40. ↑ Ruilope LM, Dukat A, Böhm M, Lacourcière Y, Gong J, Lefkowitz MP (2010). "Blood-pressure reduction with LCZ696, a novel dual-acting inhibitor of the angiotensin II receptor and neprilysin: a randomised, double-blind, placebo-controlled, active comparator study". Lancet. 375 (9722): 1255–66. doi:10.1016/S0140-6736(09)61966-8. PMID 20236700.
  41. ↑ Byrd JB, Adam A, Brown NJ (2006). "Angiotensin-converting enzyme inhibitor-associated angioedema". Immunol Allergy Clin North Am. 26 (4): 725–37. doi:10.1016/j.iac.2006.08.001. PMID 17085287.
  42. ↑ Toh S, Reichman ME, Houstoun M, Ross Southworth M, Ding X, Hernandez AF; et al. (2012). "Comparative risk for angioedema associated with the use of drugs that target the renin-angiotensin-aldosterone system". Arch Intern Med. 172 (20): 1582–9. doi:10.1001/2013.jamainternmed.34. PMID 23147456. Review in: Evid Based Med. 2013 Dec;18(6):e52
  43. ↑ Makani H, Messerli FH, Romero J, Wever-Pinzon O, Korniyenko A, Berrios RS; et al. (2012). "Meta-analysis of randomized trials of angioedema as an adverse event of renin-angiotensin system inhibitors". Am J Cardiol. 110 (3): 383–91. doi:10.1016/j.amjcard.2012.03.034. PMID 22521308.
  44. ↑ Rasmussen ER, Pottegård A, Bygum A, von Buchwald C, Homøe P, Hallas J (2019). "Angiotensin II receptor blockers are safe in patients with prior angioedema related to angiotensin-converting enzyme inhibitors - a nationwide registry-based cohort study". J Intern Med. 285 (5): 553–561. doi:10.1111/joim.12867. PMID 30618189.
  45. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).
  46. ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202

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