[Treatment of cardiac failure with angiotensin-converting enzyme inhibitors and diuretics].

Congestive cardiac failure is characterised by redistribution of blood flow to the brain and the heart at the expense of the kidneys. The prognosis of this condition at its most advanced stage (stage IV) is poor with a mortality of about 50% at 5 years. The reduction of renal perfusion will lead to stimulation of all vasoconstrictor and anti-natiuretic mechanisms, and to a parallel activation of vasodilator and natiuretic systems. There is, therefore, a clear conflict of interest between the heart, which attempts to preserve its perfusion and function, and the kidneys which aggravate the haemodynamic disturbances by salt and water overload and the risk of arrhythmias due to hypokalaemia and hypomagnesaemia. The diuretics and ACE inhibitors are essential therapeutic classes for the treatment of congestive cardiac failure. The prevention of the secondary effects of diuretics and ACE inhibitors on renal function, serum sodium, potassium and magnesium concentrations, is based on an initial low dose prescription, the detection and correction of risk factors and strict clinical and biological surveillance. In order to avoid the risks of hyperkalaemia during the association of ACE inhibitor and diuretic therapy with a potassium sparing agent, the initial dose of these two drugs should be as low as possible.