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ACE Inhibitors in Pediatric Patients with Heart Failure

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Abstract

This article reviews reports of ACE inhibitor use in pediatric heart failure and summarizes the present implications for clinical practice. Captopril, enalapril, and cilazapril are orally active ACE inhibitors, and widely used in pediatric cardiology, although more than ten other ACE inhibitors have been applied clinically in adults. Effects of ACE inhibitors on the renin-angiotensin-aldosterone system in pediatric patients are similar to those in adults. ACE inhibitors lower aortic pressure and systemic vascular resistance, do not affect pulmonary vascular resistance significantly, and lower left atrial and right atrial pressures in pediatric patients with heart failure. In infants with a large ventricular septal defect and pulmonary hypertension, ACE inhibitors decrease left-to-right shunt in those infants with elevated systemic vascular resistance. ACE inhibitors induce a small increase in left ventricular ejection fraction, left ventricular fractional shortening, and systemic blood flow in children with left ventricular dysfunction, mitral regurgitation, and aortic regurgitation. These beneficial effects usually persist long term without the development of tolerance. Therapeutic trials of ACE inhibitors have been reported in children with heart failure and divergent hemodynamics, including myocardial dysfunction, left-to-right shunt, such as large ventricular septal defect and pulmonary hypertension, aortic or mitral regurgitation, and Fontan circulation.

Hypotension and renal failure usually occur within 5 days after starting ACE inhibition or increasing the dose and, in most cases, recovery is seen after reduction or cessation of the drug. With all ACE inhibitors, smaller doses are administered initially to prevent excessive hypotension, and doses are increased gradually to the target dose. Captopril is administered orally, usually every 8 hours. Daily doses range from 0.3 to 1.5 mg/kg in children. Enalapril is administered orally, once or twice a day, and daily doses range from 0.1 to 0.5 mg/kg. Enalaprilat is administered intravenously, one to three times a day, in doses ranging from 0.01 to 0.05 mg/kg/dose.

For the treatment of chronic heart failure in children, ACE inhibitors are essential along with other medications including diuretics, digoxin, and β-blockers (β-adrenoceptor antagonists).

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References

  1. Nadas AS, Fyler DC. Pediatric cardiology. 3rd ed. Philadelphia (PA): Saunders, 1972: 262–75

    Google Scholar 

  2. Keith JD, Rowe RD, Vlad P. Heart disease in infancy and childhood. 3rd ed. New York: Macmillan, 1978: 163–84

    Google Scholar 

  3. Taylor JFN. The management of heart failure in paediatric practice. In: Graham G, Rossi E, editors. Heart disease in infants and children. London: Edward Arnold, 1980: 151–66

    Google Scholar 

  4. Talner NS. Heart failure. In: Moss AJ, Adams FH, Emmanouilides GC, editors. Heart disease in infants, children, and adolescents. 2nd ed. Baltimore (MD): Williams & Wilkins, 1977: 660–75

    Google Scholar 

  5. Gorodischer R. Cardiac drugs. In: Yaffe SI, editor. Pediatric pharmacology. New York: Grune & Stratton, 1980: 281–304

    Google Scholar 

  6. Talner NS. Heart failure. In: Adams FH, Emmanouilides GC, editors. Moss’ heart disease in infants, children, and adolescents. 3rd ed. Baltimore (MD): Williams & Wilkins, 1983: 708–24

    Google Scholar 

  7. Cohn JN, Franciosa JA. Vasodilator therapy of cardiac failure (first of two parts). N Engl J Med 1977; 297(1): 27–31

    Article  PubMed  CAS  Google Scholar 

  8. Cohn JN, Franciosa JA. Vasodilator therapy of cardiac failure (second of two parts). N Engl J Med 1977; 297(5): 254–8

    Article  PubMed  CAS  Google Scholar 

  9. Rubin SA, Swan HJC. Vasodilator therapy for heart failure: concept, applications, and challenges. JAMA 1981 Feb; 245: 761–3

    Article  PubMed  CAS  Google Scholar 

  10. Katz AM. Changing strategies in the management of heart failure. J Am Coll Cardiol 1989; 13(3): 513–23

    Article  PubMed  CAS  Google Scholar 

  11. Mason DT. Afterload reduction and cardiac performance: physiologic basis of systemic vasodilators as a new approach in treatment of congestive heart failure. Am J Med 1978; 65: 106–25

    Article  PubMed  CAS  Google Scholar 

  12. Chatterjee K, Parmley WW, Cohn JN, et al. A cooperative multicenter study of captopril in congestive heart failure: hemodynamic effects and long-term response. Am Heart J 1985; 110: 439–47

    Article  PubMed  CAS  Google Scholar 

  13. Artman M. Pharmacological therapy. In: Emmanouilides GC, Riemenschneider TA, Allen HD, et al., editors. Moss and Adams’ heart disease in infants, children, and adolescents. 5th ed. Baltimore (MD): Williams & Wilkins, 1995: 375–98

    Google Scholar 

  14. Dillon TR, Janos GG, Meyer RA, et al. Vasodilator therapy for congestive heart failure. J Pediatr 1980 Apr; 96(4): 623–9

    Article  PubMed  CAS  Google Scholar 

  15. Talner NS. Heart failure. In: Adams FH, Emmanouilides GC, editors. Moss’ heart disease in infants, children, and adolescents. 4th ed. Baltimore (MD): Williams & Wilkins, 1989: 890–910

    Google Scholar 

  16. Beekman RH, Rocchini AP, Rosenthal A. Hemodynamic effects of nitroprusside in infants with a large ventricular septal defect. Circulation 1981; 64(3): 553–8

    Article  PubMed  CAS  Google Scholar 

  17. Dzau VJ, Colucci WS, Hollenberg NK, et al. Relation of renin-angiotensin-aldosterone system to clinical state in congestive heart failure. Circulation 1981; 63: 645–51

    Article  PubMed  CAS  Google Scholar 

  18. Curtiss C, Cohn JN, Vrobel T, et al. Role of the renin-angiotensin system in the systemic vasoconstriction of chronic congestive heart failure. Circulation 1978; 58: 763–70

    Article  PubMed  CAS  Google Scholar 

  19. Jackson EK, Garrison JC. Renin and angiotensin. In: Hardman JG, Limbird LE, Morlinjoff PB, et al. editors. Goodman & Gilman’s pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill, 1996: 733–58

    Google Scholar 

  20. Davis R, Ribner HS, Keung E, et al. Treatment of chronic congestive heart failure with captopril, an oral inhibitor of angiotensin-converting enzyme. N Engl J Med 1979; 301: 117–21

    Article  PubMed  CAS  Google Scholar 

  21. Schneeweiss A. Drug therapy in infants and children with cardiovascular disease. Philadelphia (PA): Lee & Febiger, 1986: 181–232

    Google Scholar 

  22. Friedman WF, George BL. Treatment of congestive heart failure by altering loading conditions of the heart. J Pediatr 1985; 106(5): 697–706

    Article  PubMed  CAS  Google Scholar 

  23. Gottlieb SS, Dickstein K, Fleck E, et al. Hemodynamic and neurohormonal effects of the angiotensin II antagonist losartan in patients with congestive heart failure. Circulation 1993; 88 (Pt 1): 1602–9

    Article  PubMed  CAS  Google Scholar 

  24. Pitt B, Poole-Wilson AP, Segal R, et al. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomized trial. The Losartan Heart Failure Survival Study ELITE II. Lancet 2000; 355: 1582–7

    Article  PubMed  CAS  Google Scholar 

  25. Williams Jr JF, Bristow MR, Fowler MB, et al. Guidelines for evaluation and management of heart failure: report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol 1995; 26: 1376–98

    Article  Google Scholar 

  26. Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary: a report of the American College of Cardiology/American Heart Association Task force on practice guidelines (committee to revise the 1995 guidelines for the evaluation and management of heart failure). Circulation 2001; 104: 2996–3007

    Article  PubMed  CAS  Google Scholar 

  27. Waagstein F, Hjalmarson A, Varnauskas E, et al. Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy. Br Heart J 1975; 37: 1022–36

    Article  PubMed  CAS  Google Scholar 

  28. Cohn JN, Levine TB, Olivari MT, et al. Plasma noradrenaline as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 1984; 311: 819–23

    Article  PubMed  CAS  Google Scholar 

  29. Engelmeier RS, O’Connell JB, Walsh R, et al. Improvement in symptoms and exercise tolerance by metoprolol in patients with dilated cardiomyopathy: a double-blind, randomized, placebo-controlled trial. Circulation 1985; 72(3): 536–46

    Article  PubMed  CAS  Google Scholar 

  30. Eichhorn EJ, Bristow MR. Practical guidelines for initiation of beta-adrenergic blockade in patients with chronic heart failure. Am J Cardiol 1997; 79: 794–7

    Article  PubMed  CAS  Google Scholar 

  31. Olson TM, Chan DP. Dilated congestive cardiomyopathy. In: Allen HD, Gutgesell HP, Clark EB, et al., editors. Moss and Adams’ heart disease in infants, children, and adolescents. 6th ed. Philadelphia (PA): Lippincott Williams & Wilkins, 2001: 1187–96

    Google Scholar 

  32. Colucci WS, Braunwald E. Pathophysiology of heart failure. In: Braunwald E. Zipes DP, Libby P, editors. Heart disease. 6th ed. Philadelphia (PA): W.B. Saunders, 2001: 503–33

    Google Scholar 

  33. Talner NS, McGovern JJ, Carboni MP. Congestive heart failure. In: Moller JH, Hoffman JIE, editors. Pediatric cardiovascular medicine. New York: Churchill Livingstone, 2000: 817–32

    Google Scholar 

  34. Tynan M, Anderson RH. Ventricular septal defect. In: Anderson RH, Baker EJ, Macartney RFJ, et al., editors. Paediatric cardiology. 2nd ed. London: Churchill Livingstone, 2002: 983–1014

    Google Scholar 

  35. Calvalho JS. Cardiomyopathies. In: Anderson RH, Baker EJ, Macartney RFJ, et al., editors. Paediatric cardiology. 2nd ed. London: Churchill Livingstone, 2002: 1595–643

    Google Scholar 

  36. Baylen BG, Johnson G, Tsang R, et al. The occurrence of hyperaldosteronism in infants with congestive heart failure. Am J Cardiol 1980; 45: 305–10

    Article  PubMed  CAS  Google Scholar 

  37. Hein S, Arnon E, Kostin S, et al. Progression from compensated hypertrophy to failure in the pressure-overloaded human heart. Circulation 2003; 107: 984–91

    Article  PubMed  Google Scholar 

  38. Baker KM, Aceto JE. Angiotensin II stimulation of protein synthesis and cell growth in chick heart cell. Am J Physiol 1990; 259: H610–8

    PubMed  CAS  Google Scholar 

  39. Sadoshima J, Izumo S. Signal transduction pathways of angiotensin II-induced c-fos gene expression in cardiac myocytes in vitro. Circ Res 1993; 73: 424–38

    Article  PubMed  CAS  Google Scholar 

  40. Sadoshima J, Izumo S. Molecular characterization of angiotensin II-induced hypertrophy of cardiac myocytes and hyperplasia of cardiac fibroblasts. Circ Res 1993; 73: 413–23

    Article  PubMed  CAS  Google Scholar 

  41. Suzuki J, Matsubara H, Urakami M, et al. Rat angiotensin II (type 1A) receptor mRNA regulation and subtype expression in myocardial growth and hypertrophy. Circ Res 1993; 73: 439–47

    Article  PubMed  CAS  Google Scholar 

  42. Pinto YM, Pinto-Siesma S-J, Philipp T, et al. Reduction in left ventricular messenger RNA for transforming growth factor betal attenuates left ventricular fibrosis and improves survival without lowering blood pressure in hypertensive TGR(mRen2)27 rat. Hypertension 2000; 36: 747–54

    Article  PubMed  CAS  Google Scholar 

  43. Schultz JEJ, Witt SA, Glascock BJ, et al. TGF-betal mediate the hypertrophic cardiomyocyte growth induced by angiotensin II. J Clin Invest 2002; 109: 787–96

    CAS  Google Scholar 

  44. Kromer EP, Riegger GAJ. Effects of long-term angiotensin converting enzyme inhibition on myocardial hypertrophy in experimental aortic stenosis in the rat. Am J Cardiol 1988; 62: 161–3

    Article  PubMed  CAS  Google Scholar 

  45. Osaki S, Kinugawa T, Ogino K, et al. Effects of acute and chronic alacepril treatment on exercise capacity and hemodynamics in patients with heart failure: a preliminary study. Int J Clin Pharmacol Therap 2002; 40(2): 69–74

    CAS  Google Scholar 

  46. Grassi G, Cattaneo BM, Seravalle G, et al. Effects of chronic ACE inhibition on sympathetic nerve traffic and baroreflex control of circulation in heart failure. Circulation 1997; 96: 1173–9

    Article  PubMed  CAS  Google Scholar 

  47. Cremonesi G, Cavalieri L, Cikes I, et al. Fixed combinations of delapril plus indapamide vs fosinopril plus hydrochlorothiazide in mild to moderate essential hypertension. Adv Ther 2002; 19(3): 129–37

    Article  PubMed  CAS  Google Scholar 

  48. Auslender M, Artman M. Drugs and dosages. In: Moller JH, Hoffman JIE, editors. Pediatric cardiovascular medicine. New York: Churchill Livingstone, 2000: 953–69

    Google Scholar 

  49. Pinto YM, van Veldhuisen DJ, Tjon-Ka-Jie RT, et al. Dose-finding study of imidapril, a novel angiotensin converting enzyme inhibitor, in patients with stable chronic heart failure. Europ J Clin Pharmacol 1996; 50(4): 265–8

    Article  CAS  Google Scholar 

  50. Simpson K, Jarvis B. Lisinopril: a review of its use in congestive heart failure. Drugs 2000; 59(5): 1149–67

    Article  PubMed  CAS  Google Scholar 

  51. Simpson D, Noble S, Goa KL. Perindopril: in congestive heart failure. Drugs 2002; 629: 1367–77

    Article  Google Scholar 

  52. Acanfora D, Furgi G, Trojano L, et al. Quinapril in patients with congestive heart failure: controlled trial versus captopril. Am J Therapeut 1997; 4: 181–8

    Article  CAS  Google Scholar 

  53. Lamy A, Yusuf S, Pogue J, et al. Cost implications of the use of ramipril in high-risk patients based on the Heart Outcome Prevention Evaluation (HOPE) study. Circulation 2003; 107: 960–5

    Article  PubMed  Google Scholar 

  54. Iwanaga Y, Kihara Y, Inagaki K, et al. Differential effects of angiotensin II versus endothelin-1 inhibitions in hypertrophie left ventricular myocardium during transition to heart failure. Circulation 2001; 104(4): 606–12

    Article  PubMed  CAS  Google Scholar 

  55. Mulder P, Boujedaini H, Richard V, et al. Long-term survival and hemodynamics after endothelin-a receptor antagonism and angiotensin-converting enzyme inhibition in rats with chronic heart failure: monotherapy versus combined therapy. Circulation 2002; 106(9): 1159–64

    Article  PubMed  CAS  Google Scholar 

  56. Beekman RH, Rocchini AP, Dick II M, et al. Vasodilator therapy in children: acute and chronic effects in children with left ventricular dysfunction or mitral regurgitation. Pediatrics 1984; 37(1): 43–51

    Google Scholar 

  57. Shaw NJ, Wilson N, Dickinson DF. Captopril in heart failure secondary to a left to right shunt. Arch Dis Childh 1988; 63: 360–3

    Article  PubMed  CAS  Google Scholar 

  58. Shaddy RE, Teitel DF, Brett C. Short-term hemodynamic effects of captopril in infants with congestive heart failure. Am J Dis Child 1988; 142(1): 100–5

    PubMed  CAS  Google Scholar 

  59. Scammell AM, Arnold R. The effect of the first dose of captopril on blood pressure in infants in heart failure. Int J Cardiol 1089; 22: 377–9

    Article  Google Scholar 

  60. Montigny M, Davignon A, Fouron J-C, et al. Captopril in infants for congestive heart failure secondary to a large ventricular left-to-right shunt. Am J Cardiol 1989; 63(5): 631–3

    Article  PubMed  CAS  Google Scholar 

  61. Schneeweiss A. Cardiovascular drugs in children II: angiotensin-converting enzyme inhibitors in pediatric patients. Pediatr Cardiol 1990; 11: 199–207

    Article  PubMed  CAS  Google Scholar 

  62. Stern H, Weil J, Genz T, et al. Captopril in children with dilated cardiomyopathy: acute and long-term effects in a prospective study of hemodynamic and hormonal effects. Pediatr Cardiol 1990; 11(1): 22–8

    Article  PubMed  CAS  Google Scholar 

  63. Bengur AR, Beekman RH, Rocchini AP, et al. Acute hemodynamic effects of captopril in children with a congestive or restrictive cardiomyopathy. Circulation 1991; 83(2): 523–7

    Article  PubMed  CAS  Google Scholar 

  64. Lewis AB, Chabot M. The effects of treatment with angiotensin-converting enzyme inhibitors on survival of pediatric patients with dilated cardiomyopathy. Pediatr Cardiol 1993; 14(1): 9–12

    PubMed  CAS  Google Scholar 

  65. Alehan D, Ozkutlu S. Beneficial effects of 1-year captopril therapy in children with chronic aortic regurgitation who have no symptoms. Am Heart J 1988; 135(4): 598–603

    Article  Google Scholar 

  66. Frenneaux M, Stewart RAH, Newman CMH, et al. Enalapril for severe heart failure in infancy. Arch Dis Child 1989; 64: 219–23

    Article  PubMed  CAS  Google Scholar 

  67. Lloyd TP, Mahoney L, Knoedel P, et al. Orally administered enalapril for infants with congestive heart failure: a dose-finding study. J Pediatr 1989; 114(4): 650–4

    Article  PubMed  CAS  Google Scholar 

  68. Rheuban KS, Carpenter MA, Ayers CA, et al. Acute hemodynamic effects of converting enzyme inhibition in infants with congestive heart failure. J Pediatr 1990; 117(4): 668–70

    Article  PubMed  CAS  Google Scholar 

  69. Seguchi M, Nakazawa M, Momma K. Effect of enalapril on infants and children with congestive heart failure. Cardiol Young 1992; 2(1): 14–9

    Article  Google Scholar 

  70. Webster MWI, Neutze JM, Calder AL. Acute hemodynamic effects of converting enzyme inhibition in children with intracardiac shunts. Pediatr Cardiol 1992; 13: 129–35

    PubMed  CAS  Google Scholar 

  71. Sluysmans T, Styns-Cailteux M, Tremouroux-Wattiez M, et al. Intravenous enalaprilat and oral enalapril in congestive heart failure secondary to ventricular septal defect in infancy. Am J Cardiol 1992; 70(2): 959–62

    Article  PubMed  CAS  Google Scholar 

  72. Leversha AM, Wilson NJ, Clarkson PM, et al. Efficacy and dosage of enalapril in congenital and acquired heart disease. Arch Dis Child 1994; 70(1): 35–9

    Article  PubMed  CAS  Google Scholar 

  73. Eronen M, Pesonen E, Wallgren EI, et al. Enalapril in children with congestive heart failure. Acta Paediatr Scand 1991; 80: 555–8

    Article  PubMed  CAS  Google Scholar 

  74. Nakamura H, Ishii M, Sugimura T, et al. The kinetic profile and enalaprilat and their possible developmental changes in pediatric patients with congestive heart failure. Clin Pharmacol Ther 1994; 56(2): 160–8

    Article  PubMed  CAS  Google Scholar 

  75. Kouatli AA, Garcia JA, Zellers TM, et al. Enalapril does not enhance exercise capacity in patients after Fontan procedure. Circulation 1997; 96: 1507–12

    Article  PubMed  CAS  Google Scholar 

  76. Ohuchi H, Hasegawa S, Yasuda K, et al. Severely impaired cardiac autonomic nervous action after the Fontan operation. Circulation 2001; 104: 1513–8

    Article  PubMed  CAS  Google Scholar 

  77. Lipshultz SE, Lipsitz SR, Sallan SE, et al. Long-term enalapril therapy for left ventricular dysfunction in doxorubicin-treated survivors of childhood cancer. J Clin Oncol 2002; 20(23): 4517–22

    Article  PubMed  CAS  Google Scholar 

  78. Kura S, Tunaoglu FS, Olgunturk R, et al. Atrial natriuretic peptide levels in rheumatic mitral regurgitation and response to angiotensin-converting enzyme inhibitors. Canad J Cardiol 2003; 19(4): 405–8

    Google Scholar 

  79. Mori Y, Nakazawa M, Tomimatsu H, et al. Long-term effect of angiotensin-converting enzyme inhibitor in volume overloaded heart failure during growth: a controlled pilot study. J Am Coll Cardiol 2000; 36(1): 270–5

    Article  PubMed  CAS  Google Scholar 

  80. Hazama K, Nakazawa M, Momma K. Effective dose and cardiovascular effects of cilazapril in children with heart failure. Am J Cardiol 2001; 88(2): 801–5

    Article  PubMed  CAS  Google Scholar 

  81. Gavras H, Faxon DP, Berkoben J, et al. Angiotensin converting enzyme inhibition in patients with congestive heart failure. Circulation 1978; 58(5): 770–6

    Article  PubMed  CAS  Google Scholar 

  82. Fagard R, Bulpitt C, Lunen P, et al. Response of the systemic and pulmonary circulation to converting-enzyme inhibition (captopril) at rest and during exercise in hypertensive patients. Circulation 1982; 65(1): 33–9

    Article  PubMed  CAS  Google Scholar 

  83. Cleland JGF, Dargie HJ, Hodsman GP, et al. Captopril in heart failure: a double blind controlled trial. Br Heart J 1984; 52: 530–5

    Article  PubMed  CAS  Google Scholar 

  84. Levine TB, Olivari MT, Cohn JN. Hemodynamic and regional blood flow response to captopril in congestive heart failure. Am J Med 1984; 76: 38–42

    Article  PubMed  CAS  Google Scholar 

  85. Kramer BL, Massie BM, Topic N. Controlled trial of captopril in chronic heart failure: a rest and exercise hemodynamic study. Circulation 1983; 67(4): 807–16

    Article  PubMed  CAS  Google Scholar 

  86. Packer M, Medina N, Yushak M, et al. Hemodynamic patterns of response during long-term captopril therapy for severe chronic heart failure. Circulation 1983; 68(4): 803–12

    Article  PubMed  CAS  Google Scholar 

  87. CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 1987; 316: 1429–35

    Article  Google Scholar 

  88. Creager MA, Massie BM, Faxon DP, et al. Acute and long-term effects of enalapril on cardiovascular response to exercise and exercise tolerance in patients with congestive heart failure. J Am Coll Cardiol 1985; 6(1): 163–70

    Article  PubMed  CAS  Google Scholar 

  89. Swedberg K, Eneroth P, Kjekshus J, et al. Effects of enalapril and neuroendocrine activation on prognosis in severe congestive heart failure (follow-up of the CONSENSUS trial). Am J Cardiol 1990; 66: 40D–5D

    Article  PubMed  CAS  Google Scholar 

  90. Cohn JN, Johnson G, Ziesche S, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991; 325: 303–10

    Article  PubMed  CAS  Google Scholar 

  91. Cohn JN, Archibald DG, Ziesche S, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure. N Engl J Med 1986; 314(24): 1547–52

    Article  PubMed  CAS  Google Scholar 

  92. SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991; 325: 293–302

    Article  Google Scholar 

  93. Packer M, Poole-Wilson PA, Armstrong PW, et al. Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on mortality and morbidity in chronic heart failure. Circulation 1999; 100: 2312–8

    Article  PubMed  CAS  Google Scholar 

  94. Swedberg K, Kjekshus J, Snapinn S. Long-term survival in severe heart failure in patients treated with enalapril: ten year follow-up of CONSENSUS I. Eur Heart J 1999; 20: 136–9

    Article  PubMed  CAS  Google Scholar 

  95. AIRE Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993; 342: 821–8

    Google Scholar 

  96. Drakos SG, Papamichael CM, Alexopoulos GP, et al. Effects of high doses versus standard doses of enalapril on endothelial cell function in patients with chronic congestive heart failure secondary to idiopathic dilated or ischemic cardiomy-opathy. Am J Cardiol 2003; 91: 885–8

    Article  PubMed  CAS  Google Scholar 

  97. HOPE Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355: 253–9

    Article  Google Scholar 

  98. Arnold JMO, Yusuf S, Young J, et al. Prevention of heart failure in patients in the Heart Outcomes Prevention Evaluation (HOPE) study. Circulation 2003; 107: 1284–90

    Article  PubMed  CAS  Google Scholar 

  99. Ooi H, Colucci WS. Pharmacological treatment of heart failure. In: Hardman JG, Limbird LE, editors. Goodman & Gilman’s pharmacological basis of therapeutics. 10th ed. New York: McGraw-Hill, 2001: 901–32

    Google Scholar 

  100. Todd PA, Heel RC. Enalapril: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension and congestive heart failure. Drugs 1986; 31: 198–248

    Article  PubMed  CAS  Google Scholar 

  101. Stingo L, Pocock WA, Flax H, et al. Long-term captopril therapy in severe refractory congestive heart failure. Br J Clin Pharmac 1982; 14: 203S–8S

    Article  Google Scholar 

  102. Sharpe N, Murphy J, Smith H, et al. Treatment of patients with symptomless left ventricular dysfunction after myocardial infarction. Lancet 1988; 331: 255–9

    Article  Google Scholar 

  103. Artman M. Drugs and dosages. In: Allen HD, Gutgesell HP, Clark EB, et al., editors. Moss and Adams’ heart disease in infants, children, and adolescents. 6th ed. Philadelphia (PA): Lippincott Williams & Wilkins, 2001: 1459–68

    Google Scholar 

  104. Auslender M, Artman M. Drugs and dosages. In: Möller JH, Hoffman JIC, editors. Pediatric cardiovascular medicine. New York: Churchill Livingstone, 2000: 953–69

    Google Scholar 

  105. Perry JC. Drug formulary. In: Garson Jr A, Bricker JT, Fisher DJ, et al., editors. The science and practice of pediatric cardiology. 2nd ed. Baltimore (MD): Williams & Wilkins, 1998: 2950–6

    Google Scholar 

  106. Linseman JV, Bristow MR. Drug therapy and heart failure prevention. Circulation 2003; 107: 1234–6

    Article  PubMed  Google Scholar 

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Acknowledgements

This article was supported by the Japanese Promotion Society for Cardiovascular Disease. The author has no conflicts of interest that are directly relevant to the content of this review.

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  1. Department of Pediatric Cardiology, Heart Institute, Tokyo Women’s Medical University, Kawadacho, Shinjyukuku, Tokyo, 162-8666, Japan

    Kazuo Momma

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Momma, K. ACE Inhibitors in Pediatric Patients with Heart Failure. Pediatr-Drugs 8, 55–69 (2006). https://doi.org/10.2165/00148581-200608010-00005

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