Advertisement

ACE-Inhibitors, β-Blockers, Spironolactone: Do We Need Many More Drugs to Treat Chronic Heart Failure?

  • G. Sinagra
  • G. Sabbadini
  • A. Perkan
  • S. Rakar
  • F. Longaro
  • L. Salvatore
  • G. Lardieri
  • A. Di Lenarda
Conference paper

Abstract

Over the last two decades, considerable insights into the pathophysiology of chronic congestive heart failure (HF) have been gained to suggest that the overstimulation of biologically active pathways - primarily the reninangiotensin-aldosterone and sympathoadrenergic systems - may play a key role in determining the progression of the syndrome [1]. Supporting this concept, a large body of evidence has been accumulated to show that drugs possessing the ability to counteract these up-regulated neuroendocrine mechanisms may represent an effective therapeutic strategy to improve the course of the disease [2-7].

Keywords

Heart Failure Chronic Heart Failure Heart Failure Patient Brain Natriuretic Peptide Chronic Congestive Heart Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Packer M (1992) The neurohormonal hypothesis: a theory to explain the mechanism of disease progression in heart failure. J Am Coll Cardiol 20:248–254PubMedCrossRefGoogle Scholar
  2. 2.
    Garg R,Yusuf S, for the Collaborative Group on ACE Inhibitor Trials (1995) Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA 273:1450–1456PubMedCrossRefGoogle Scholar
  3. 3.
    Packer M (2001) Current role of beta-adrenergic blockers in the management of chronic heart failure. Am J Med 110(7A):81S–94SPubMedCrossRefGoogle Scholar
  4. 4.
    Hampton JR (1994) Results of clinical trials with diuretics in heart failure. Br Heart J 72 [Suppl]:S68–S72PubMedCrossRefGoogle Scholar
  5. 5.
    Soler-Soler J, Permanyer-Miralda G (1998) Should we still prescribe digoxin in mild-to-moderate heart failure? Is quality of life the issue rather than quantity? Eur Heart J 19 [Suppl P]:P26–P31Google Scholar
  6. 6.
    Pitt B, Zannad F, Remme WJ et al, for the Randomized Aldactone Evaluation Study Investigators (RALES) (1999) The effect of spironolactone on morbidity and morta-lity in patients with severe heart failure. N Engl J Med 341:709–717PubMedCrossRefGoogle Scholar
  7. 7.
    Jong P, Demers C, McKelvie RS et al (2002) Angiotensin receptor blockers in heart failure: meta-analysis of randomized controlled trials. J Am Coll Cardiol 39:463–470PubMedCrossRefGoogle Scholar
  8. 8.
    Kostam MA, Mann DL (2002) Contemporary medical options for treating patients with heart failure. Circulation 105:2244–2246CrossRefGoogle Scholar
  9. 9.
    Stewart S, Maclntrye K, Hole DJ et al (2001) More “malignant” than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail 3:315–332PubMedCrossRefGoogle Scholar
  10. 10.
    Givertz MM, Colucci WS (1998) New targets for heart failure therapy: endothelin, inflammatory cytokines, and oxidative stress. Lancet 352 [Suppl I1:34–38Google Scholar
  11. 11.
    Cohn JN, Tognoni G, for the Valsartan Heart Failure Trial (Val-HeFT) Investigators (2001) A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 345:1667–1675Google Scholar
  12. 12.
    Coats AJ (1999) Heart failure 99: the MOXCON story. Int J Cardiol 71:109–111PubMedCrossRefGoogle Scholar
  13. 13.
    Shakar SF, Abraham WT, Gilbert EM et al (1998) Combined oral positive inotropic and beta-blocker therapy for treatment of refractory class IV heart failure. J Am Coll Cardiol 31:1336–1340PubMedCrossRefGoogle Scholar
  14. 14.
    Colucci WS, Elkayam U, Horton DP (2000) Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. N Engl J Med 343:246–253PubMedCrossRefGoogle Scholar
  15. 15.
    McLalsen A, Konig G, Thimme W (1998) Preventable causative factors leading to hospital admission with decompensated heart failure. Heart 80:437–441Google Scholar
  16. 16.
    Cleland JGF, Swedberg K, Poole-Wilson PA (1998) Successes and failures of current treatment of heart failure. Lancet 352 [Suppl 11:19–28Google Scholar
  17. 17.
    Stevenson LW (1998) Inotropic therapy for heart failure. N Engl J Med 339:1848–1850PubMedCrossRefGoogle Scholar
  18. 18.
    Troughton RW, Framptom CM, Yandle TG et al (2000) Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (n-BNP) concentrations. Lancet 355:1126–1130PubMedCrossRefGoogle Scholar
  19. 19.
    Horowitz JD (2000) Home-based intervention: the next step in treatment of chronic heart failure? Eur Heart J 21:1807–1809PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • G. Sinagra
    • 1
  • G. Sabbadini
    • 2
  • A. Perkan
    • 1
  • S. Rakar
    • 1
  • F. Longaro
    • 1
  • L. Salvatore
    • 1
  • G. Lardieri
    • 1
  • A. Di Lenarda
    • 1
  1. 1.S.C. di CardiologiaItaly
  2. 2.Cattedra di GeriatriaOspedale MaggioreTriesteItaly

Personalised recommendations