ACE inhibitors in acute and chronic ischaemia: current status and future promise.

1. Myocyte loss, reactive hypertrophy, dynamic ischaemia with ‘stunning’, and ventricular wall remodelling are all involved in the initiation and progression of myocardial failure which is ischaemic in origin. 2. The effects of ACE inhibitors to reduce preload and afterload has potentially salutary effects in these settings. Moreover, sulphyl containing ACE inhibitors may have further actions in reducing free radicals and their damage in the acute phases of these events. 3. These promising initial studies warrant further exploration.