Clinical studies on the therapy of heart failure using ACE-inhibitors and AT1-receptor blockers--does combination treatment make sense?
In all industrial nations the number of patients with heart hailure is increasing. Pharmacological treatment with Angiotensin-converting enzyme (ACE) inhibitors and beta blockers improve survival and reduce hospitalization in these patients. Inspite of these therapies, morbidity and mortality remains problematic. Possibly phenomena like the genetic induced Angiotensin-II-escape are responsible for the individual response in patients. Regarding their different pharmacological effects the new group of Angiotensin-II type 1 receptor (AT1) blockers seem to be promising for the treatment of heart failure. In trials like ELITE 1, ELITE 2 and Val-HeFT it could be demonstrated that AT1-blockers and ACE-inhibitors have a comparable effect in improving survival of heart failure patients. In the Val-HeFT study the combination of an ACE-inhibitor and an AT1-blocker reduce hospitalization and improve quality of life of heart failure patients compared with single treatment using an ACE-inhibitor or AT1-blocker. Mortality showed no significant difference. Before a final assessment of the combination treatment with ACE-inhibitors and AT1- blockers in heart failure patients we need more studies like the present CHARM-study.
Hennig
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D000803:Angiotensin I / Q000037:antagonists & inhibitors*; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000803:Angiotensin I