New therapies for the treatment of congestive heart failure.
Heart failure is characterized by sodium and fluid retention, sympathetic overactivity, parasympathetic withdrawal, vasoconstrictor activation and cytokine elevation. New therapies for heart failure attempt to control neurohormonal activation and limit progressive left ventricular dysfunction. Nesiritide (human B-type natriuretic peptide) is a recently approved new vasodilator that has been given to almost 1,000 patients in numerous clinical investigations; it belongs to a new class of heart failure drugs known as natriuretic peptides. Nesiritide decreases pulmonary capillary wedge pressure, systemic vascular resistance, mean right atrial pressure and pulmonary artery pressure, while improving cardiac index, stroke volume and heart failure symptoms. Many endothelin receptor antagonists are in various stages of development. Early clinical studies have demonstrated beneficial cardiovascular hemodynamic effects. Other new drugs for heart failure also include calcium sensitizers, neutral endopeptidase and vasopeptidase inhibitors, aldosterone receptor antagonists, vasopressin antagonists and cytokine inhibitors. All are being actively investigated and many show significant promise as beneficial therapies in the treatment of heart failure.
Burger
Andrew J
AJ
Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston Massachusetts 02215, USA. aburger@caregroup.harvard.edu
Burger
Mary R
MR
Aronson
Doron
D
D000818:Animals; D020013:Calcium Signaling / Q000187:drug effects; D016207:Cytokines / Q000037:antagonists & inhibitors; D065128:Endothelin Receptor Antagonists; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists; D045283:Natriuretic Agents / Q000627:therapeutic use; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000627:therapeutic use; D014667:Vasopressins / Q000037:antagonists & inhibitors
D016207:Cytokines; D065128:Endothelin Receptor Antagonists; D000451:Mineralocorticoid Receptor Antagonists; D045283:Natriuretic Agents; D010726:Phosphodiesterase Inhibitors; D011480:Protease Inhibitors; D014667:Vasopressins