Do All ACE Inhibitors Work For Heart Failure?

— -- Question: Do all ACE inhibitors work for heart failure?

Answer: That's a great question because for the longest time in general we believed that a class of drugs works in every individual drug within that particular class of drugs works equally well.

But as we have learned with certain other forms of drugs like statin therapy or beta blockers, that not all the drugs within the same class necessarily have the same beneficial effect.

Now when it comes particularly to ACE inhibitors, there is some sense that the ACE inhibitors functions may be different depending whether or not they are vascular specific or non-specific, whether they are lipophilic or not and whether they enter the cell membrane and penetrate the tissues better or not. But irrespective of the debate, the overwhelming data at least at this point is that whenever an ACE inhibitor is looked at in patients with heart failure and low ejection fraction, there has been in all-cause mortality benefit.

So when it comes to ACE inhibitor, I would have to say that all ACE inhibitors probably work fairly well for patients with heart failure and perhaps giving ACE inhibitors is the most essential step rather than worrying about which ACE inhibitor.

For clinical purposes, long-acting ACE inhibitors are preferable in the long run because of compliance, short acting ACE inhibitors is difficult because people tend to forget taking their medication two or three times a day, for perpetuity, so once a day ACE inhibitors probably from that perspective is better, but not necessarily from clinical effectiveness perspective.