CARDIOLOGY UPDATE

Drug therapy in chronic heart failure

D B McKenzie, A J Cowley

Department of Cardiovascular Medicine, University Hospital, Nottingham

Correspondence to:
Correspondence to:
Dr Daniel McKenzie
Department of Cardiovascular Medicine, University Hospital, Derby Road, Nottingham, NG7 2UH, UK; dan.mckenzie{at}nottingham.ac.uk

Chronic heart failure is widely recognised as a common and escalating problem that causes major disability and often shortens life. Diuretics and digoxin have formed the mainstay of treatment for many years. Clinical trials have demonstrated that angiotensin converting enzymes and ß-blockers, in selected patients, improve symptoms and reduce mortality. Angiotensin-II antagonists and spironolactone may also have a role in certain individuals. Newer pharmacological approaches to the management of this complex disease are being developed, but await full evaluation.

Abbreviations: ACE, angiotensin converting enzyme; ANP, atrial natriuretic peptide; BNP, brain natriuretic peptide; CARMEN, Carvedilol ACE Inhibitor Remodelling Mild CHF Evaluation; CHARM, Candesartan in Heart failure: Assessement of Reduction in Mortality and Morbidity; CHF, chronic heart failure; CIBIS, Cardiac Insufficiency Bisoprolol Study; COMET, Carvedilol or Metoprolol European Trial; CONSENSUS, Co-operative North Scandanavian Enalapril Survival Study; COPERNICUS, Carvedilol Prospective Randomised Cumulative Survival; ELITE, Evaluation of Losartan in The Elderly; ENABLE, Endothelin Antagonist Bosentan for Lowering Cardiac Events; IMPRESS, Inhibition of Metaloprotease by Ompatrilat in a Randomised Exercise and Symptoms Study of Heart Failure; MERIT-HF, Metoprolol CR/XL Randomised Intervention Trial in Heart Failure; NEP, neutral endopeptidase; NYHA, New York Heart Association; OPTIMAAL, Optimal Trial in Myocardial Infarction with the Angiotensin II Antagonist Losartan; OVERTURE, Ompatrilat Versus Enalapril Randomised Trial of Utility in Reducing Events; PRAISE, Prospective Randomised Amlodipine Survival Evaluation; RAAS, renin-angiotensin-aldosterone system; RALES, Randomised Aldactone Evaluation Study; RESOLVD, Randomised Evaluation of Strategies for Left Ventricular Dysfunction; SENIORS, Study of the Effects of Nebivolol Intervention on Outcome and Rehospitalisations in Seniors with Heart Failure; SOLVD, Studies of Left Ventricular Dysfunction; Val-HeFT, Valsartan Heart Failure Trial; V-HeFT, Vasodilator Heart Failure Trial

Keywords: chronic heart failure; drug therapy; ß-blockers; angiotensin II antagonists; spironolactone

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