ACE inhibitors often have different effects in patients with heart failure

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

According to health experts, about two to three million people in Germany suffer from heart failure (heart failure). Patients are often prescribed ACE inhibitors. But not all patients respond equally to such drugs. Researchers have now discovered why this is so.

Nearly two million Germans suffer from heart failure

Chronic heart failure (cardiac insufficiency) is a growing challenge in Western society due to its frequency, mortality and hospitalization. It is associated with a long course of illness, high suffering and poor prognosis for patients. In Germany alone, almost two million people are affected. 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 people affected respond individually to the basic therapy administered ACE inhibitors very differently.

Although many patients with heart failure are receiving ACE inhibitors for therapy, these drugs do not help all sufferers alike, researchers report. (Image: Photographee.eu/fotolia.com)

Why not all patients benefit equally from an ACE inhibitor

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

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

Currently, ACE inhibitors are very commonly used in heart muscle inflammation. However, a cross-sectional study by the Medical University (MedUni) Vienna has now shown that patients respond individually to these drugs very differently.

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

Basic therapy of chronic heart failure

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

The overactivation of this hormone system is believed to be an essential mechanism that favors the progression of the disease.

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

Therefore, the recommendation is to prescribe an ACE inhibitor to anyone with heart failure.

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

Individually extremely different therapy response

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

This was possible with a novel complex mass spectrometric analysis, which represents the hormone system holistically.

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

In addition, it could be shown that the activation of the crucial peptides can be estimated directly by means of easily determinable renin, so that future investigations can also be carried out on large patient numbers.

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

For the first time, this gives an explanation why not all patients benefit from an ACE inhibitor. Here, other body-own overactivated systems may dominate the clinical picture.

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

Precision medicine for heart failure

The findings of the study support efforts in the development of a targeted individualized therapy in heart failure with the possibility of a therapy adjustment according to the existing phenotype with already known drugs.

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