Roles of neurohumoral factors in the progression of heart failure.

has led to an appreciation of the clinical importance of achieving regression of cardiac hypertrophy, as well as control of blood pressure, in patients receiving antihypertensive therapy. The superiority of converting enzymeinhibitors compared to other antihypertensive agents in effecting regression of cardiac hypertrophy could be attributable to their characteristic profile of actions. By inhibiting the production of A II, they not only decrease afterload through blood pressure reduction, but also ameliorate myocardial ischemia through improvement in myocardial blood flow resulting from increased myocardial and arteriolar compliance due to reduction in the size of individual myocardial cells and regression of interstitial and perivascular tissue flbrosis. Recent findings that converting enzyme inhibitors improve the prognosis for patients with heart failure can be readily understood based on the underlying pathological events leading to a hypertrophic heart.