Angiotensin-converting enzyme dysfunction

Until recently, the cardiotonics and a diuretic were the treatment of choice for HE However, other dragp such as the angiotensin-converting enzyme (ACE) inhibitors, and beta blockers have become the treatment of choice during the last several years. See Figure 39-1 for an example of a method of determining treatment for left ventricular systolic dysfunction. See Chapters 23, 42, and 46 for more information on the beta blockers, ACE inhibitors, and diuretics, respectively. 

Chymostatin-sensitive Il-generating enzyme Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction Trial Collaborative Study Captopril Trial ( The Effect of Angiotensin-Converting Enzyme Inhibition on Diabetic Nephropathy ) calcium channel blocking agents Candesartan in Heart Failure Assessment of Reduction in Morbidity and Mortality Trial congestive heart failure, but the latest recommendations use HF for heart failure chronic kidney disease cardiac output... 

To control risk factors and prevent major adverse cardiac events, statin therapy should be considered in all patients with ischemic heart disease, particularly in those with elevated low-density lipoprotein cholesterol. In the absence of contraindications, angiotensin-converting enzyme inhibitors should be considered in ischemic heart disease patients who also have diabetes melli-tus, left ventricular dysfunction, history of myocardial infarction, or any combination of these. Angiotensin receptor blockers... 

Butler R, Morris AD, Burchell B, Struthers AD. DD angiotensin-converting enzyme gene polymorphism is associated with endothelial dysfunction in normal humans. Hypertension 1999 33 1164-1168. 

Angiotensin-converting enzyme inhibitor (ACEI) to patients with CAD and diabetes or LV dysfunction... 

Exner, C.V., et al., "Lesser Response to Angiotensin-Converting-Enzyme Inhibitor Therapy in Black as Compared with White Patients with Left Ventricular Dysfunction," N. Engl. J. Med., 344, 1351-1357 (2001). 

The Angiotensin Converting Enzyme Inhibitors (ACE-I) are recommended for all CAD patients, especially those with Diabetes Mellitus (DM) and/or left ventricle (LV) dysfunction. 

Shekelle PG et al Efficacy of angiotensin-converting enzyme inhibitors and beta blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status A meta-analysis of major clinical trials. J Am Coll Cardiol 2003 41 1529. [PMID 12742294]... 

Chen H, Mohuczy D, Li D, et al. Protection against ischemia/reperfusion injury and myocardial dysfunction by anti-sense-oligodeoxynucleotide directed at angiotensin-converting enzyme mRNA. Gene Ther 2001 8 804-810. 

Konstam MA, Kronenberg MW, Rousseau Mp et al, Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dilatation in patients with asymptomatic systolic dysfunction, SOLVD (Studies of Left Ventricular Dysfunction) Investigators, Circulation 1993 88 2277-2283. 

Echemann M, Zannad F, Briancon S, JuUhere Y, Mertes PM, Virion JM, Villemot JP. Determinants of angiotensin-converting enzyme inhibitor prescription in severe heart failure with left ventricular systolic dysfunction the EPICAL study. Am Heart J 2000 139(4) 624-31. 

Lehmann K, Ritz E. Angiotensin-converting enzyme inhibitors may cause renal dysfunction in patients on long-term lithium treatment. Am J Kidney Dis. 1995 25 82-87. 

The current national guidelines recommend that all patients be given the following unless contraindications exist (1) aspirin, (2) /S-blockers with prior MI, (3) angiotensin-converting enzyme (ACE) inhibitor to patients with CAD and diabetes or LV systolic dysfunction, (4) LDL-lowering therapy with CAD and an LDL concentration... 

K0ber L, Torp-Pedersen C, Carlsen JE, et al. A clinical trial of the Angiotensin-Converting-Enzyme Inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. The Trandolapril Cardiac Evaluation (TRACE) study group. N Engl J Med 1995 333(25) 1670—6. 

Captopril, an angiotensin-converting enzyme inhibitor (ACE), is indicated in the management of hypertension by itself or in combination with other antihypertensive medications, in heart failure when the patients have not responded adequately to digitalis, after myocardial infarction associated with left ventricular dysfunction, and in diabetic nephropathy (Figure 25). 

Trandolapril is an angiotensin-converting enzyme (ACE) inhibitor that reduces the formation of the vasopressor hormone angiotensin II by inhibiting ACE. It Results in decreased BP and reduced sodium reabsorption and potassium retention. Heart failure post-MMeft-ventricular dysfunction post-MI used for stable patients who have... 

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