Abstract
Specific blockers of the angiotensin type1 receptor, angiotensin receptor blockers (ARBs), have been introduced as an alternative to angiotensin-converting enzyme inhibitors (ACEi) for the treatment of heart failure. In comparison with ACEi, ARBs are better tolerated and have similar effects on haemodynamics, neurohormones and exercise capacity. Early studies have suggested that ARBs might have a superior effect on mortality. However, the first outcome trial, ELITE II (Losartan Heart Failure Survival Study), did not show any significant difference between losartan and captopril in terms of mortality or morbidity. This commentary outlines the role of ARBs in the treatment of heart failure.
Highlights
Angiotensin-converting-enzyme inhibitors (ACEi) improve survival and decrease morbidity in patients with heart failure (HF) [1], asymptomatic left ventricular systolic dysfunction [2], myocardial infarction [3] and high cardiovascular risk [4]
The haemodynamic and neurohormonal effects in HF patients are similar to those of ACEi [8,9,10,11,12,13,14], and short-term studies have indicated that angiotensin receptor blockers (ARBs) are at least as efficacious as ACEi in terms of exercise capacity and symptoms [10,11]
The doses of ARBs maturely owing to adverse events, excluding deaths, in the used in other ongoing trials in HF are equivalent to four losartan group (9.7% compared with 14.7%, P = 0.001)
Summary
Angiotensin-converting-enzyme inhibitors (ACEi) improve survival and decrease morbidity in patients with heart failure (HF) [1], asymptomatic left ventricular systolic dysfunction [2], myocardial infarction [3] and high cardiovascular risk [4]. Specific blockers of the angiotensin type 1 receptor (AT1 receptor), angiotensin receptor blockers (ARBs), have been introduced as an alternative to ACEi. Specific receptor blockade is potentially advantageous compared with the non-specific interaction of ACEi and expectations are high that ARBs will prove to be a useful therapeutic option in HF. Tolerance and efficacy of ARBs ARBs are well tolerated, even by HF patients who cannot tolerate an ACEi [7], and the side effects are at the placebo level. The haemodynamic and neurohormonal effects in HF patients are similar to those of ACEi [8,9,10,11,12,13,14], and short-term studies have indicated that ARBs are at least as efficacious as ACEi in terms of exercise capacity and symptoms [10,11]. In a study of 844 HF patients a dose-dependent increase in exercise capacity was demonstrated for candesartan [15]
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