Rationalizing the heart failure trials: from theory to practice.
It is 10 years since the CONSENSUS I study showed that ACE inhibitors improved mortality in heart failure. This finding has been confirmed in numerous trials, for example SOLVD, SAVE. Indeed, in the intervening 10 years, many other potential therapies have been examined in mortality trials, but so far no other therapy has had as good effect on mortality as ACE inhibitors. The other therapies which have been examined are digoxin, amlodipine, beta-blockers, amiodarone, etc. Despite ACE inhibitors being a very effective therapy for heart failure, there is still remarkable under-use of them in clinical practice. The reason for this needs to be explained further, but fear of hypothermia and renal dysfunction appear to be major factors.
Struthers
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AD
Department of Clinical Pharmacology, Ninewells Hospital, Dundee, UK.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000638:Amiodarone / Q000627:therapeutic use; D017311:Amlodipine / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002986:Clinical Trials as Topic; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006830:Hydralazine / Q000627:therapeutic use; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D004232:Diuretics; D014665:Vasodilator Agents; D017311:Amlodipine; D006830:Hydralazine; D004077:Digoxin; D000638:Amiodarone