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ACE inhibitors often work differently in patients with heart failure


Chronic heart failure: Not all patients respond equally to ACE inhibitors

According to health experts, around two to three million people in Germany suffer from heart failure (heart failure). Affected people are often prescribed ACE inhibitors. But not all patients respond equally to such drugs. Researchers have now found out why.

Almost two million Germans suffer from heart failure

Chronic heart failure (heart muscle weakness) is an increasing challenge in Western society due to its frequency, mortality and hospital admission. It is associated with a long course of the disease, high suffering and poor prognosis for the patients. Almost two million people are affected in Germany alone. As a result of this disease, the heart is no longer able to provide the body with sufficient blood and oxygen. A study has now shown that those affected respond very differently to the ACE inhibitors administered for basic therapy.

Why not all patients benefit equally from an ACE inhibitor

In recent years, new approaches to the treatment of heart failure have been reported time and again.

For example, scientists at the Hannover Medical School (MHH) found that more iron could help some patients because it makes the heart more resilient.

At present, ACE inhibitors are very often used for myocarditis. However, a cross-sectional study by the Medical University (MedUni) Vienna has now shown that patients respond very differently to these drugs individually.

The findings of the study published in the journal "Clinical Chemistry" support the efforts in the development of targeted individualized therapy (precision medicine) in heart failure, according to a communication from the university.

Basic therapy for chronic heart failure

According to the experts, the basic therapy for chronic heart failure has been the ACE inhibitor (angiotensin-converting-enzyme inhibitor) for 25 years. It influences the renin-angiotensin system, which regulates the volume balance and blood pressure.

The over-activation of this hormone system is believed to be an essential mechanism that promotes the progression of the disease.

The use of ACE inhibitors not only improves patient complaints or performance, it also prevents hospital admissions and extends survival.

So far, the recommendation has been to prescribe an ACE inhibitor to everyone with heart failure.

At the same time, you know that you cannot help every patient with it. Apparently there are different phenotypes in heart failure, which consequently influence the response to the therapy.

Individually extremely different therapy response

The cross-sectional study was carried out by Noemi Pavo at the heart failure outpatient clinic of the Clinical Department of Cardiology at MedUni Vienna / AKH Vienna and examined for the first time the entire renin-angiotensin system in patients with chronic systolic heart failure under ACE inhibitors.

This was possible with a new, complex, mass spectrometric analysis that maps the hormone system holistically.

Despite comparable types and doses of medication and regardless of the severity of the heart failure, the patients showed an individually extremely different therapy response at the molecular level of the renin-angiotensin system.

In addition, it was shown that the activation of the crucial peptides can be estimated directly using the easily determinable renin, so that future studies can also be carried out on large numbers of patients.

Significant in this context is the new finding that the renin-angiotensin system mentioned above is apparently not activated at all or only insignificantly in many patients with heart failure.

For the first time, this gives an approach to explaining why not all patients benefit from an ACE inhibitor. Here, other over-activated systems in the body may dominate the clinical picture.

On the other hand, there are many patients with excessive activation of the renin-angiotensin system who may need more aggressive therapy.

Precision medicine for heart failure

The findings of the study support the efforts in the development of a targeted individualized therapy in heart failure with the possibility of a therapy adjustment depending on the phenotype present with already known drugs.

At the same time, they open up further questions regarding the regulation of the renin-angiotensin system with the potential development of new approaches to heart failure therapy. (ad)

Author and source information

Video: Living with Heart Failure: ACE InhibitorsARBs (August 2020).