PMID- 16493245
OWN - NLM
STAT- MEDLINE
DCOM- 20060613
LR  - 20121115
IS  - 1061-5377 (Print)
IS  - 1061-5377 (Linking)
VI  - 14
IP  - 2
DP  - 2006 Mar-Apr
TI  - Suppression of the renin-angiotensin-aldosterone system in chronic heart failure: 
      choice of agents and clinical impact.
PG  - 81-7
AB  - Chronic heart failure (CHF) has taken on epidemic proportions in the United 
      States, with approximately 550,000 new cases annually. With the evolution of 
      pharmacotherapy targeting neurohormonal pathways over the past 2 decades, the 
      annual mortality in subjects with New York Heart Association (NYHA) class IV has 
      dramatically improved from 52% in the seminal CONSENSUS trial to less than 20% in 
      more recent trials in CHF. Suppression of the renin-angiotensin system (RAS) with 
      various angiotensin-converting enzyme (ACE) inhibitors has been proven to save 
      lives in several large-scale trials of CHF, and all of them can be used at doses 
      tested in clinical trials without clear preference of one over another. 
      Angiotensin receptor blockers (ARBs) can be used in place of ACE inhibitors in 
      the case of ACE inhibitor intolerance with comparable results. However, some 
      inconsistencies exist between trials with ARBs, and it is uncertain if the ARBs 
      tested in clinical trials provide comparable clinical benefit whether used in 
      place of or in combination with ACE inhibitors. Once ACE inhibition has been 
      started, beta blockade should follow for all subjects with symptomatic CHF. 
      Triple neurohormonal blockade can then be accomplished with the addition of an 
      aldosterone receptor or ARB. Regardless of the exact agent used or sequence of 
      initiation, the critical importance of careful monitoring of neurohormonal 
      blockade cannot be overstated. Renal failure and hyperkalemia are the most 
      important complications of suppression of the renin-angiotensin-aldosterone 
      system (RAAS), and an increase in hospital admissions and death from hyperkalemia 
      after publication of the RALES trial illustrates the danger of "casual" use of 
      neurohormonal blockers. In light of the tremendous benefits of neurohormonal 
      blockade, the only conclusion from these data is to initiate RAAS-blocking agents 
      following the safety precautions tested in the respective clinical trials.
FAU - Jorde, Ulrich P
AU  - Jorde UP
AD  - Heart Failure Center, Leon Charney Division of Cardiology, New York University 
      School of Medicine, New York, New York, USA. Ulrich.jorde@med.nyu.edu
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Cardiol Rev
JT  - Cardiology in review
JID - 9304686
RN  - 0 (Angiotensin II Type 1 Receptor Blockers)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Mineralocorticoid Receptor Antagonists)
SB  - IM
MH  - Angiotensin II Type 1 Receptor Blockers/pharmacology/*therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/pharmacology/*therapeutic use
MH  - Clinical Trials as Topic
MH  - Cost Control
MH  - Drug Therapy, Combination
MH  - Evidence-Based Medicine
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Mineralocorticoid Receptor Antagonists/therapeutic use
MH  - Renin-Angiotensin System/drug effects
RF  - 47
EDAT- 2006/02/24 09:00
MHDA- 2006/06/14 09:00
CRDT- 2006/02/24 09:00
PHST- 2006/02/24 09:00 [pubmed]
PHST- 2006/06/14 09:00 [medline]
PHST- 2006/02/24 09:00 [entrez]
AID - 00045415-200603000-00005 [pii]
AID - 10.1097/01.crd.0000201550.94389.50 [doi]
PST - ppublish
SO  - Cardiol Rev. 2006 Mar-Apr;14(2):81-7. doi: 10.1097/01.crd.0000201550.94389.50.