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Combining neuroendocrine inhibitors in heart failure: reflections on safety and efficacy.
Am J Med. 2007 Dec; 120(12):1090.e1-8.AJ

Abstract

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.

Authors+Show Affiliations

Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Jneid.Hani@mgh.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18060931

Citation

Jneid, Hani, et al. "Combining Neuroendocrine Inhibitors in Heart Failure: Reflections On Safety and Efficacy." The American Journal of Medicine, vol. 120, no. 12, 2007, pp. 1090.e1-8.
Jneid H, Moukarbel GV, Dawson B, et al. Combining neuroendocrine inhibitors in heart failure: reflections on safety and efficacy. Am J Med. 2007;120(12):1090.e1-8.
Jneid, H., Moukarbel, G. V., Dawson, B., Hajjar, R. J., & Francis, G. S. (2007). Combining neuroendocrine inhibitors in heart failure: reflections on safety and efficacy. The American Journal of Medicine, 120(12), e1-8.
Jneid H, et al. Combining Neuroendocrine Inhibitors in Heart Failure: Reflections On Safety and Efficacy. Am J Med. 2007;120(12):1090.e1-8. PubMed PMID: 18060931.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combining neuroendocrine inhibitors in heart failure: reflections on safety and efficacy. AU - Jneid,Hani, AU - Moukarbel,George V, AU - Dawson,Bart, AU - Hajjar,Roger J, AU - Francis,Gary S, PY - 2006/10/31/received PY - 2007/02/24/revised PY - 2007/02/26/accepted PY - 2007/12/7/pubmed PY - 2008/1/17/medline PY - 2007/12/7/entrez SP - 1090.e1 EP - 8 JF - The American journal of medicine JO - Am. J. Med. VL - 120 IS - 12 N2 - 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. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/18060931/Combining_neuroendocrine_inhibitors_in_heart_failure:_reflections_on_safety_and_efficacy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(07)00565-7 DB - PRIME DP - Unbound Medicine ER -