A hard look at angiotensin receptor blockers in heart failure

Multiple trials over the past several years have examined indications for angiotensin receptor blockers (ARBs) in the treatment of left ventricular dysfunction, both acutely after myocardial infarction and in chronic heart failure. Yet despite these data, there is still confusion regarding the effic...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2004-11, Vol.44 (9), p.1841-1846
Main Authors: Gring, Christian N., Francis, Gary S.
Format: Article
Language:English
Subjects:
ACE inhibitors
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors - administration & dosage
Angiotensin-Converting Enzyme Inhibitors - standards
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Biological and medical sciences
Blood Pressure - drug effects
Cardiology
Cardiology. Vascular system
Cardiomyopathy
Cardiovascular disease
Dose-Response Relationship, Drug
Drug therapy
Enzymes
Health Planning Guidelines
Heart
Heart attacks
Heart failure
Heart Failure - drug therapy
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Humans
Medical prognosis
Medical sciences
Morbidity
Mortality
Patients
Randomized Controlled Trials as Topic
Receptors, Angiotensin - therapeutic use
Stroke Volume - drug effects
Ventricular Dysfunction, Left - drug therapy
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Summary:Multiple trials over the past several years have examined indications for angiotensin receptor blockers (ARBs) in the treatment of left ventricular dysfunction, both acutely after myocardial infarction and in chronic heart failure. Yet despite these data, there is still confusion regarding the efficacy of ARBs as monotherapy in these patient populations, as well as the specific indications for combination ARB/angiotensin-converting enzyme (ACE) inhibitor therapy. We examine the key differences among the trials—including the ACE inhibitor dose, the ARB and its dose, blood pressure reduction, and patient populations—to present our perspective on ARB use, alone or in combination with ACE inhibitors, in patients with chronic heart failure and post-myocardial infarction left ventricular dysfunction. We conclude that ACE inhibitors remain the first-line therapy for left ventricular dysfunction. Angiotensin receptor blockers should be reserved for monotherapy in ACE intolerant patients and for combination therapy in symptomatic class II/III patients with chronic heart failure.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2004.07.044