Angiotensin-Converting Enzyme Inhibitor and/or Angiotensin Receptor Antagonist for the Postmyocardial Infarction Patient

The utilization of angiotensin-II attenuating agents is the standard of care in the management of patients with left ventricular dysfunction regardless of the etiology. The most effective agents of this group includes both angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists (ARB). Given the worse outcomes noted in those patients who have coronary artery disease, efforts to optimize appropriate pharmacotherapy in this population is imperative. There does appear to be some advantage in the combination of ACE+ARB in chronic left ventricular dysfunction patients. In those patients that have sustained a recent myocardial infarction with concomitant left ventricular dysfunction, the combination of ACE+ARB does not improve survival and in fact might exacerbate renal dysfunction as well as hypotension. The appropriate employment of agents that attenuate the effects of angiotensin-II should be a priority in the care and management of the left ventricular dysfunction patient.