ACE inhibitors and beta-blockers reduce mortality in a broad range of patients with left ventricular systolic dysfunction, including men and women, blacks and whites, and diabetics and nondiabetics. However, the value of ACE inhibitors in women with asymptomatic left ventricular systolic dysfunction is uncertain, and additional study is needed. In addition, based on data from a single study, the beta-blocker bucindolol may be associated with increased mortality in blacks, whereas other beta-blockers provide similar benefits in blacks and whites.
Treatment of asymptomatic left ventricular dysfunction with ACE inhibitors is very cost- effective. In addition, screening for asymptomatic left ventricular dysfunction with B-type natriuretic peptide followed by echocardiography is cost-effective in populations where the prevalence of this condition is 1% or greater.