[Drug therapy of heart failure. What choice in 1996?].
The mortality of heart failure remains high despite recent therapeutic progress. The objectives of treatment are to relieve symptoms, but also to improve survival. The secondary objectives are extension of the duration of effort, improvement of the ejection fraction, reduction of arrhythmias and neuroendocrine disturbances, although these criteria are not strictly related to the primary objectives. Diuretics should be used from the first symptoms, but their effect on survival has not been evaluated. Digitalis alkaloids, with no effect on survival, also improve functional signs, even in patients in sinus rhythm. All other positive inotropic agents increase mortality. Nitrates improve symptoms and, when associated with hydralazine, prolong survival. Amiodarone should be reserved to patients with dangerous arrhythmias. Angiotensin converting enzyme inhibitors have the best demonstrated effect on survival and must be used as first-line treatment. Their preventive effect on mortality is limited, except in post-infarction ventricular dysfunction. Beta-blockers, which appear very promising for the improvement of survival, functional signs and ejection fraction, are currently under evaluation. Their mechanisms of action and the choice of the most active drugs have yet to be determined.
Witchitz
S
S
Service de Cardiologie, Hôpital Bicêtre, Le Kremlin Bicetre.
Arsenescu
I
I
Pellerin
D
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics
Les traitements medicamenteux de l'insuffisance cardiaque. Quel choix en 1996?