Update on therapy for heart failure

The success of angiotensin-converting enzyme (ACE) inhibitors in reducing morbidity and mortality in patients with heart failure has led to investigations of other inhibitors of the renin-angiotensin-aldosterone system. Although ACE inhibitors remain first-line drugs in the treatment of heart failure and left ventricular dysfunction, clinical evidence suggests that a newer class of agents-angiotensin II receptor blockers-may provide additional benefit by blocking the adverse effects of angiotensin 11 more completely. An improved adverse-effect profile also makes angiotensin 11 receptor blockers appropriate in patients who cannot tolerate ACE inhibitors. Clinical trials have demonstrated the beneficial effects of angiotensin 11 receptor blockers on the combined endpoints of morbidity and mortality in patients with heart failure. Aldosterone antagonism with spironolactone has additive benefits in patients receiving an ACE inhibitor. The most recent treatment guidelines for heart failure recommend the use of angiotensin 11 receptor blockers and spironolactone in selected patients. (C) 2003 by Excerpta Medica Inc.