title: Practical recommendations for the use of ACE inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers in heart failure: putting guidelines into practice.
abstract: Surveys of prescribing patterns in both hospitals and primary care have usually shown delays in translating the evidence from clinical trials of pharmacological agents into clinical practice, thereby denying patients with heart failure (HF) the benefits of drug treatments proven to improve well-being and prolong life. This may be due to unfamiliarity with the evidence-base for these therapies, the clinical guidelines recommending the use of these treatments or both, as well as concerns regarding adverse events. ACE inhibitors have long been the cornerstone of therapy for systolic HF irrespective of aetiology. Recent trials have now shown that treatment with beta-blockers, aldosterone antagonists and angiotensin receptor blockers also leads to substantial improvements in outcome. In order to accelerate the safe uptake of these treatments and to ensure that all eligible patients receive the most appropriate medications, a clear and concise set of clinical recommendations has been prepared by a group of clinicians with practical expertise in the management of HF. The objective of these recommendations is to provide practical guidance for non-specialists, in order to increase the use of evidenced based therapy for HF. These practical recommendations are meant to serve as a supplement to, rather than replacement of, existing HF guidelines.
authors.affiliation: Department of Cardiology, Western Infirmary, Glasgow, G12 8QQ, UK. j.mcmurray@bio.gla.ac.uk
authors.forename: John
authors.initials: J
authors.lastname: McMurray
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.forename: Rainer
authors.initials: R
authors.lastname: Dietz
authors.forename: Eric
authors.initials: E
authors.lastname: Eichhorn
authors.forename: Leif
authors.initials: L
authors.lastname: Erhardt
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.forename: Aldo
authors.initials: A
authors.lastname: Maggioni
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKelvie
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.forename: Jordi
authors.initials: J
authors.lastname: Soler-Soler
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000008:administration & dosage / Q000627:therapeutic use; D001578:Benzopyrans / Q000008:administration & dosage / Q000627:therapeutic use; D001713:Biphenyl Compounds; D017298:Bisoprolol / Q000008:administration & dosage / Q000627:therapeutic use; D002216:Captopril / Q000008:administration & dosage / Q000627:therapeutic use; D002227:Carbazoles / Q000008:administration & dosage / Q000627:therapeutic use; D000077261:Carvedilol; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000008:administration & dosage / Q000627:therapeutic use; D004983:Ethanolamines / Q000008:administration & dosage / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000627:therapeutic use; D017706:Lisinopril / Q000008:administration & dosage / Q000627:therapeutic use; D008790:Metoprolol / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D000068577:Nebivolol; D017410:Practice Guidelines as Topic; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use; D017257:Ramipril / Q000008:administration & dosage / Q000627:therapeutic use; D013148:Spironolactone / Q000627:therapeutic use; D013318:Stroke Volume; D013777:Tetrazoles / Q000008:administration & dosage / Q000627:therapeutic use; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles; D001578:Benzopyrans; D001713:Biphenyl Compounds; D002227:Carbazoles; D004983:Ethanolamines; D007211:Indoles; D000451:Mineralocorticoid Receptor Antagonists; D011412:Propanolamines; D013777:Tetrazoles; D000068577:Nebivolol; D000077261:Carvedilol; C052035:trandolapril; D013148:Spironolactone; D004656:Enalapril; D000068756:Valsartan; D002216:Captopril; D017706:Lisinopril; D008790:Metoprolol; D014633:Valine; D017257:Ramipril; C081643:candesartan; D017298:Bisoprolol