ACE-inhibitor pada HFrEF dan HFpEF

Abstract

Heart failure (HF) is a complex clinical syndrome with symptoms and signs resulting from structural or functional disorders of ventricular filling or ejection. It is known that excessive activation of the renin-angiotensin-system (RAS) contributes to the pathophysiology of HF. Therefore, RAS inhibitors, including angiotensin converting enzyme (ACE) inhibitors (ACE-i) are indicated for the treatment of heart failure, However, many studies have found that ACE-inhibitors are ineffective for HFpEF. This is likely due to differences in the pathophysiology of HFrEF and HFpEF. The differences in the pathophysiology of HFrEF and HFpEF lie in aspects of inflammation and endothelial function, hypertrophy and death of cardiomyocytes, and fibrosis. ACE-i has been proven to reduce mortality and hospitalization in HFrEF, but is still controversial in HFpEF. However, ACE-i is still indicated for hypertension control in HFpEF. . Other therapies may be added such as βblockers or CCB to achieve specific goals.