Hypertension and heart failure -: ACE-inhibitors or AT1-receptor antagonists?

Essential hypertension is a common disease that leads in a high percentage to congestive heart failure. In heart failure loss of myocardial contractility causes neuroendocrine activation - especially activation of the renin-angiotensin system (RAS). The treatment of heart failure aims to inhibit this activation. ACE-inhibitors lead to a reduced production of the effector substance angiotensin II and by that mechanism effectively block the activation of the RAS. In major clinical trials significant benefits of ACE-inhibitor treatment in heart failure were clearly demonstrated in addition, AT(1)-receptor antagonists are novel drugs that may lead to a more effective blockade of the RAS. Clinical trials are currently investigating the benefit of these drugs in heart failure. First results are encouraging but major morbidity and mortality trials have not been completed yet An advantage of the treatment with AT(1)-receptor antagonists seems to be a lower rate of adverse events. To date, it is unknown whether different pharmacological interventions in the RAS by ACE-inhibitors and AT(1)-receptor antagonists lead to a different clinical benefit Combination of both drugs may be of additional use and could presumably demonstrate another promising possibility of treatment However, the question whether AT(1)-receptor antagonists alone or in combination with ACE-inhibitors exert definite benefits in heart failure treatment remains unanswered until completion of the major mortality trials.