Beta blockers or angiotensin-converting-enzyme inhibitor/angiotensin receptor blocker: what should be first?
The historical choice of angiotensin-converting enzyme (ACE) inhibition as first-line therapy in heart failure is challenged by early activation of the sympathetic system and multiple ways beta blockade (in particular, unselective agents such as carvedilol) may affect cardiac remodeling, its underlying mechanisms, and, hence, progression of heart failure, compared with ACE inhibition. Existing comparisons indicate similar or possible greater efficacy of beta blockade than ACE inhibition. As beta blockade is well tolerated, it could be considered in individual stable patients. However, early combined treatment with both neurohormonal antagonists remains preferable to either neurohormonal antagonist alone and should not be delayed.
Sticares Cardiovascular Research Institute, Rhoon, The Netherlands. w.j.remme@sticares.org
Willem J
WJ
Remme
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D017298:Bisoprolol / Q000494:pharmacology / Q000627:therapeutic use; D002227:Carbazoles / Q000494:pharmacology / Q000627:therapeutic use; D000077261:Carvedilol; D017147:Defibrillators, Implantable; D018450:Disease Progression; D004656:Enalapril / Q000494:pharmacology / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D020913:Perindopril / Q000494:pharmacology / Q000627:therapeutic use; D011412:Propanolamines / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000187:drug effects / Q000502:physiology
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D004656:Enalapril; D017298:Bisoprolol; D020913:Perindopril