心力衰竭是当今现代工业化社会最严重的健康问题之一。人口平均年龄的增加是另一个因素，有利于心力衰竭发作的高发生率。年龄也是与心力衰竭相关的死亡率的相关因素。在此基础上，研究人员和医生更加重视改善心力衰竭的预防和治疗方法。多年来，心力衰竭患者的药物治疗是基于通过洋地黄增加肌力和通过利尿剂减少钠水潴留，而后负荷的改善不太重要。我们已经对慢性心力衰竭的血管舒张药物有至少20年的了解，但仅在10年前，血管扩张剂-心力衰竭试验（V-HeFTI），事实证明，除了常规治疗外，肼屈嗪和硝酸盐的组合，改善中重度心力衰竭患者的生存率。随着ACE抑制剂的出现，在80年代，有关此类药物在心力衰竭中的作用的第一批研究已经进行。在合作北斯堪的纳维亚依那普利生存研究（CONSENSUSI）中，首次证明了ACE抑制剂（依那普利），添加到传统的心力衰竭治疗中，改善了严重充血性心力衰竭（NYHAIV级）患者的生存率。结果是如此非凡，以至于该研究因道德原因而中断。然而,它引起了人们对ACE抑制剂在心力衰竭中的研究的相当大的兴趣，现在已经证明这类药物是正确的心力衰竭药理学方法的里程碑。
Heart failure is today one of the most serious health problems of modern industrialized societies. The increase in the mean age of the population is an additional factor which favours a high incidence of episodes of heart failure. Age is also a relevant factor in mortality linked with heart failure. On this basis more emphasis has been given by researchers and physicians to improve a preventive and therapeutic approach to heart failure. For many years the pharmacological treatment of heart failure patients was based on the increase in inotropism through the digitalis and on the reduction in sodium-water retention through diuretics, while less importance was given to the improvement of the afterload. We have had knowledge of vasodilatory drugs in chronic heart failure for at least 20 years but only 10 years ago with the Vasodilator-Heart Failure Trial (V-HeFTI), it was proved that the combination of hydralazine and nitrates in addition to the conventional treatment, improved the survival of patients affected by moderate-severe heart failure. With the advent of the ACE-inhibitors, in the \'80s, the first studies concerning the role of such drugs in heart failure were carried out. In the Cooperative North Scandinavian Enalapril Survival Study (
CONSENSUS I) it was proved for the first time that an ACE-inhibitor (enalapril), added to the conventional heart failure therapy, improved the survival of patients with severe congestive heart failure (NYHA class IV). The result was so extraordinary that the study was interrupted for ethical reasons. However, it has raised a considerable interest in the study of the ACE-inhibitors in heart failure and now it has been proved that such drugs are a milestone in a correct pharmacological approach to heart failure.
