Combined renin-angiotensin-aldosterone system inhibition in patients with chronic heart failure secondary to left ventricular systolic dysfunction.
The prevalence of heart failure (HF) is high and still on the rise. In 2004, an estimated 5.2 million adults in the United States carried the diagnosis of HF with a mortality rate of >19%. The incidence of HF is higher in individuals 65 years or older. As the US population grows older, the personal and economic costs of this disease are expected to grow. More than 75% of patients with HF have a history of hypertension, and blood pressure control can reduce the risk of serious cardiovascular events and death in this population. In addition to lowering blood pressure, blockade of the renin-angiotensin-aldosterone system can reduce the negative effects of chronic renin-angiotensin-aldosterone system activation on the progression of HF. This review discusses the clinical data supporting the use of angiotensin-converting enzyme inhibitors and angiotensin receptors blockers, alone or in combination, for improving outcomes in patients with HF.
Gradman
Alan H
AH
Division of Cardiovascular Diseases, The Western Pennsylvania Hospital, Pittsburgh, PA15224-1722, USA. gradmanmd@aol.com
Papademetriou
Vasilios
V
D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D054143:Heart Failure, Systolic / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008297:Male; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D011945:Receptors, Angiotensin / Q000008:administration & dosage; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000401:mortality
D047228:Angiotensin II Type 1 Receptor Blockers; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D011945:Receptors, Angiotensin