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• 作者：Atsuro Uchida ; Miki Uchino ; Eiki Goto ; Eri Hosaka ; Yuko Kasuya ; Kazumi Fukagawa ; Murat Dogru ; Yoko Ogawa ; Kazuo Tsubota
• 关键词：Aldosterone ; Angiotensin ; Beta-blocker ; Heart failure ; Neuroendocrine ; Systolic dysfunction
• 刊名：American Journal of Ophthalmology
• 出版年：2008
• 出版时间：January 2008
• 年：2008
• 卷：145
• 期：1
• 页码：184-185
• 全文大小：46 K

文摘

Neuroendocrine activation in heart failure has become the major target of pharmacotherapy for this growing epidemic. Agents targeting the renin-angiotensin-aldosterone and sympathetic nervous systems have shown cardiovascular and survival benefits in clinical trials. Beta-blockers and angiotensin-converting enzyme (ACE) inhibitors remain the mainstream initial therapy. The benefits of aldosterone antagonists have been demonstrated in advanced heart failure (spironolactone) and after myocardial infarction complicated by left ventricular dysfunction and heart failure (eplerenone). Emerging clinical evidence demonstrated that angiotensin receptor blockers may be a reasonable alternative to ACE inhibitors in patients with heart failure (candesartan) and following myocardial infarction complicated by heart failure or left ventricular dysfunction (valsartan). Angiotensin receptor blockers (candesartan) also provided incremental benefits when added to ACE inhibitors in chronic heart failure. Thus, combining neuroendocrine inhibitors in heart failure appears both biologically plausible and evidence-based. However, this approach raised concerns about side effects, such as hypotension, renal insufficiency, hyperkalemia, and others. Close follow-up and implementation of evidence-based medicine (ie, using agents and doses proven beneficial in clinical trials) should therefore be undertaken when combining neuroendocrine inhibitors.