Multiple renin-angiotensin-aldosterone-blocking agents in heart failure: How much is too much?
Tóm tắt
Angiotensin-converting enzyme inhibitors (ACE-Is) and β-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.
Tài liệu tham khảo
Dickstein K, Kjekshus J: Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan. Lancet 2002, 360:752–760.
Pfeffer MA, McMurray JJ, Velazquez EJ, et al.: Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003, 349:1893–1906. [Published erratum appears in N Engl J Med 2004, 350:203.]
Yusuf S, Teo KK, Pogue J, et al.: Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008, 358:1547–1559.
Pitt B, Poole-Wilson PA, Segal R, et al.: Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial-the Losartan Heart Failure Survival Study ELITE II. Lancet 2000, 355:1582–1587.
Cohn JN, Tognoni G: A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001, 345:1667–1675.
McMurray JJ, Ostergren J, Swedberg K, et al.: Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 2003, 362:767–771.
Indications for ACE inhibitors in the early treatment of acute myocardial infarction: systematic overview of individual data from 100,000 patients in randomized trials. ACE Inhibitor Myocardial Infarction Collaborative Group [no authors listed]. Circulation 1998, 97:2202–2212.
Rodrigues EJ, Eisenberg MJ, Pilote L: Effects of early and late administration of angiotensin-converting enzyme inhibitors on mortality after myocardial infarction. Am J Med 2003, 115:473–479.
Pfeffer MA, Greaves SC, Arnold JM, et al.: Early versus delayed angiotensin-converting enzyme inhibition therapy in acute myocardial infarction. The healing and early afterload reducing therapy trial. Circulation 1997, 95:2643–2651.
Pfeffer MA, Hennekens CH: When a question has an answer: rationale for our early termination of the HEART Trial. Am J Cardiol 1995, 75:1173–1175.
Latini R, Maggioni AP, Flather M, et al.: ACE inhibitor use in patients with myocardial infarction. Summary of evidence from clinical trials. Circulation 1995, 92:3132–3137.
Krum H, Carson P, Farsang C, et al.: Effect of valsartan added to background ACE inhibitor therapy in patients with heart failure: results from Val-HeFT. Eur J Heart Fail 2004, 6:937–945.
McMurray JJ, Young JB, Dunlap ME, et al.: Relationship of dose of background angiotensin-converting enzyme inhibitor to the benefits of candesartan in the Candesartan in Heart Failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Added trial. Am Heart J 2006, 151:985–991.
Lakhdar R, Al-Mallah MH, Lanfear DE: Safety and tolerability of angiotensin-converting enzyme inhibitor versus the combination of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker in patients with left ventricular dysfunction: a systematic review and meta-analysis of randomized controlled trials. J Card Fail 2008, 14:181–188.
Mann JF, Schmieder RE, McQueen M, et al.: Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 2008, 372:547–553.
Matchar DB, McCrory DC, Orlando LA, et al.: Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension. Ann Intern Med 2008, 148:16–29.
Mak G, Murphy NF, Ali A, et al.: Multiple neurohumoral modulating agents in systolic dysfunction heart failure: are we lowering blood pressure too much? J Card Fail 2008, 14:555–560.
Pitt B, Zannad F, Remme WJ, et al.: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999, 341:709–717.
Pitt B, Remme W, Zannad F, et al.: Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003, 348:1309–1321. [Published erratum appears in N Engl J Med 2003, 348:2271.]
Montezano AC, Callera GE, Yogi A, et al.: Aldosterone and angiotensin II synergistically stimulate migration in vascular smooth muscle cells through c-Src-regulated redox-sensitive RhoA pathways. Arterioscler Thromb Vasc Biol 2008, 28:1511–1518.
Pitt B, Reichek N, Willenbrock R, et al.: Effects of eplerenone, enalapril, and eplerenone/enalapril in patients with essential hypertension and left ventricular hypertrophy: the 4E-left ventricular hypertrophy study. Circulation 2003, 108:1831–1838.
Pitt B: Aldosterone blockade in patients with systolic left ventricular dysfunction. Circulation 2003, 108:1790–1794.
Banas J: Absence of clinical hypotension with eplerenone in post acute myocardial infarction patients with heart failure and left ventricular systolic dysfunction. Results from Ephesus. Am J Cardiol 2006, A(Suppl):227A.
McMurray J, Pitt B, Latini R, et al.: Effects of the oral direct renin inhibitor aliskiren in patients with symptomatic heart failure. Circ Heart Fail 2008, 1:17–24.
Pitt B, McMurray J, Latini R, et al.: Heart failure: neurohormonal modulation [abstract]. Circulation 2007, 116:2491.
Fisher ND, Hollenberg NK: Renin inhibition: what are the therapeutic opportunities? J Am Soc Nephrol 2005, 16:592–599.