Update on the pharmacological management of congestive heart failure.
The incidence of heart failure (HF) is increasing while numerous pharmacological breakthroughs have been accomplished in the last two decades. Mortality remains high and is comparable to mortality due to oncologic disease. Coronary artery disease and hypertension are the primary causes of heart failure in Western societies while valvular heart disease is a significant cause in economically underdeveloped societies. While there are many pharmacological therapies for systolic disfunction, little is known about the optimal way to treat diastolic dysfunction. Although William Withering described the properties of digitalis in 1785, two hundred years passed before a scientific trial documented its benefit in HF. Skilled dissection and probing of the molecular basis of cardiac muscle contraction led to the development of numerous compounds postulated to be more effective than digitalis, only to disappoint repeatedly in numerous trials. In contrast, ACE inhibitors (ACEI) revolutionized the management of HF and it is unlikely that another class of agents will show dramatic improvements like the ACEI. Therefore, the pharmacological therapy of HF is proving to be more an art than a science, as numerous agents have to be tuned against each other to produce an overall effect that is beneficial.
Thomas
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B
British Hospital, Lisboa.
Vagueiro
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MC
D000465:Algorithms; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans
D002316:Cardiotonic Agents