title: Multiple renin-angiotensin-aldosterone-blocking agents in heart failure: how much is too much?
abstract: Angiotensin-converting enzyme inhibitors (ACE-Is) and beta-adrenergic receptor blockers (BBs) have been effective in reducing cardiovascular morbidity and mortality in patients with heart failure (HF) and left ventricular systolic dysfunction (LVSD). Angiotensin receptor blockers and aldosterone blockers have also been shown to be effective. Although ACE-Is and BBs remain the therapies of choice for patients with HF-LVSD, many clinicians have attempted to further reduce patient morbidity and mortality by adding another inhibitor or blocker of the renin-angiotensin-aldosterone system to an ACE-I or BB. This article reviews the efficacy and safety of adding another renin-angiotensin-aldosterone system inhibitor or blocker to an ACE-I or an angiotensin receptor blocker plus a BB in patients with HF-LVSD.
authors.affiliation: University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48104, USA. bpitt@umich.edu
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D012084:Renin-Angiotensin System / Q000187:drug effects*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists