From digoxin to angiotensin-converting enzyme inhibitors: issues in pharmacotherapy for congestive heart failure.
Congestive heart failure (CHF) is a disease with high mortality rates and increasing prevalence in the United States. As our understanding of the pathophysiologic characteristics of this disease has progressed, so has our pharmacologic approach to treatment. Digoxin was the first documented drug used in the treatment of CHF, and since that time, the efficacy of its use has been the source of great controversy. A more recent treatment option is the use of angiotensin-converting enzyme (ACE) inhibitors, the first drug class shown to increase survival rates in CHF. Although controversy remains, ACE inhibitors appear to be gaining favor over digoxin in the pharmacologic approach to treatment. This article provides a pathophysiologic review of CHF as it is understood today, the rationale behind the use of digoxin and ACE inhibitors, and a challenge for the future in the pharmacotherapy of CHF.
Georgetown University, Washington, DC, USA. hackenbh@hotmail.com
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Hackenbruck
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004077:Digoxin / Q000494:pharmacology / Q000627:therapeutic use*; D018450:Disease Progression; D005544:Forecasting; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D018579:Patient Selection; D015995:Prevalence; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004077:Digoxin