Congestive heart failure angiotensin receptor blockers: Difference between revisions

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(/* ACC/AHA Guidelines- Angiotensin II Receptor Blockers Recommendation Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, ...)
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{|class="wikitable"
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| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
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|bgcolor="LemonChiffon"|'''1.''' [[Angiotensin II receptor blockers]] are reasonable to use as alternatives to [[ACEIs|ACE inhibitors]] as first-line therapy for patients with mild to moderate [[heart failure]] and reduced [[left ventricular ejection fraction]] ([[LVEF]]), especially for patients already taking [[Angiotensin II receptor blockers|ARBs]] for other indications.<ref name="pmid14610160">{{cite journal |author=Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Køber L, Maggioni AP, Solomon SD, Swedberg K, Van de Werf F, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM |title=Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both |journal=[[The New England Journal of Medicine]] |volume=349 |issue=20 |pages=1893–906 |year=2003 |month=November |pmid=14610160 |doi=10.1056/NEJMoa032292 |url=http://dx.doi.org/10.1056/NEJMoa032292 |accessdate=2012-04-05}}</ref><ref name="pmid13678870">{{cite journal |author=Granger CB, McMurray JJ, Yusuf S, Held P, Michelson EL, Olofsson B, Ostergren J, Pfeffer MA, Swedberg K |title=Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial |journal=[[Lancet]] |volume=362 |issue=9386 |pages=772–6 |year=2003 |month=September |pmid=13678870 |doi=10.1016/S0140-6736(03)14284-5 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(03)14284-5 |accessdate=2012-04-05}}</ref><ref name="pmid8403307">{{cite journal |author=Gottlieb SS, Dickstein K, Fleck E, Kostis J, Levine TB, LeJemtel T, DeKock M |title=Hemodynamic and neurohormonal effects of the angiotensin II antagonist losartan in patients with congestive heart failure |journal=[[Circulation]] |volume=88 |issue=4 Pt 1 |pages=1602–9 |year=1993 |month=October |pmid=8403307 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=8403307 |accessdate=2012-04-05}}</ref><ref name="pmid7828295">{{cite journal |author=Crozier I, Ikram H, Awan N, Cleland J, Stephen N, Dickstein K, Frey M, Young J, Klinger G, Makris L |title=Losartan in heart failure. Hemodynamic effects and tolerability. Losartan Hemodynamic Study Group |journal=[[Circulation]] |volume=91 |issue=3 |pages=691–7 |year=1995 |month=February |pmid=7828295 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=7828295 |accessdate=2012-04-05}}</ref><ref name="pmid10577995">{{cite journal |author=Riegger GA, Bouzo H, Petr P, Münz J, Spacek R, Pethig H, von Behren V, George M, Arens H |title=Improvement in exercise tolerance and symptoms of congestive heart failure during treatment with candesartan cilexetil. Symptom, Tolerability, Response to Exercise Trial of Candesartan Cilexetil in Heart Failure (STRETCH) Investigators |journal=[[Circulation]] |volume=100 |issue=22 |pages=2224–30 |year=1999 |month=November |pmid=10577995 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10577995 |accessdate=2012-04-05}}</ref><ref name="pmid10955375">{{cite journal |author=Sharma D, Buyse M, Pitt B, Rucinska EJ |title=Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. Losartan Heart Failure Mortality Meta-analysis Study Group |journal=[[The American Journal of Cardiology]] |volume=85 |issue=2 |pages=187–92 |year=2000 |month=January |pmid=10955375 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914999006463 |accessdate=2012-04-05}}</ref><ref name="pmid10477530">{{cite journal |author=McKelvie RS, Yusuf S, Pericak D, Avezum A, Burns RJ, Probstfield J, Tsuyuki RT, White M, Rouleau J, Latini R, Maggioni A, Young J, Pogue J |title=Comparison of candesartan, enalapril, and their combination in congestive heart failure: randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD Pilot Study Investigators |journal=[[Circulation]] |volume=100 |issue=10 |pages=1056–64 |year=1999 |month=September |pmid=10477530 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10477530 |accessdate=2012-04-05}}</ref><ref name="pmid9740480">{{cite journal |author=Mazayev VP, Fomina IG, Kazakov EN, Sulimov VA, Zvereva TV, Lyusov VA, Orlov VA, Olbinskaya LI, Bolshakova TD, Sullivan J, Spormann DO |title=Valsartan in heart failure patients previously untreated with an ACE inhibitor |journal=[[International Journal of Cardiology]] |volume=65 |issue=3 |pages=239–46 |year=1998 |month=August |pmid=9740480 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(98)00149-1 |accessdate=2012-04-05}}</ref><ref name="pmid11759645">{{cite journal |author=Cohn JN, Tognoni G |title=A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure |journal=[[The New England Journal of Medicine]] |volume=345 |issue=23 |pages=1667–75 |year=2001 |month=December |pmid=11759645 |doi=10.1056/NEJMoa010713 |url=http://dx.doi.org/10.1056/NEJMoa010713 |accessdate=2012-04-05}}</ref><ref name="pmid12225725">{{cite journal |author=Wong M, Staszewsky L, Latini R, Barlera S, Volpi A, Chiang YT, Benza RL, Gottlieb SO, Kleemann TD, Rosconi F, Vandervoort PM, Cohn JN |title=Valsartan benefits left ventricular structure and function in heart failure: Val-HeFT echocardiographic study |journal=[[Journal of the American College of Cardiology]] |volume=40 |issue=5 |pages=970–5 |year=2002 |month=September |pmid=12225725 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109702020636 |accessdate=2012-04-05}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
|bgcolor="LightCoral"|'''1.''' Routine combined use of an [[ACEIs|ACE inhibitor]], [[Angiotensin II receptor blockers|ARB]], and [[aldosterone antagonist]] is not recommended for patients with current or prior symptoms of [[heart failure]] and reduced [[left ventricular ejection fraction]] ([[LVEF]]). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|}
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{|class="wikitable"
{|class="wikitable"
|-
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
|bgcolor="LemonChiffon"|'''1.''' The addition of an [[angiotensin II receptor blockers]] may be considered in persistently symptomatic patients with reduced [[left ventricular ejection fraction]] who are already being treated with conventional therapy. <ref name="pmid14610160">{{cite journal |author=Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Køber L, Maggioni AP, Solomon SD, Swedberg K, Van de Werf F, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM |title=Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both |journal=[[The New England Journal of Medicine]] |volume=349 |issue=20 |pages=1893–906 |year=2003 |month=November |pmid=14610160 |doi=10.1056/NEJMoa032292 |url=http://dx.doi.org/10.1056/NEJMoa032292 |accessdate=2012-04-05}}</ref><ref name="pmid13678870">{{cite journal |author=Granger CB, McMurray JJ, Yusuf S, Held P, Michelson EL, Olofsson B, Ostergren J, Pfeffer MA, Swedberg K |title=Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial |journal=[[Lancet]] |volume=362 |issue=9386 |pages=772–6 |year=2003 |month=September |pmid=13678870 |doi=10.1016/S0140-6736(03)14284-5 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(03)14284-5 |accessdate=2012-04-05}}</ref><ref name="pmid8403307">{{cite journal |author=Gottlieb SS, Dickstein K, Fleck E, Kostis J, Levine TB, LeJemtel T, DeKock M |title=Hemodynamic and neurohormonal effects of the angiotensin II antagonist losartan in patients with congestive heart failure |journal=[[Circulation]] |volume=88 |issue=4 Pt 1 |pages=1602–9 |year=1993 |month=October |pmid=8403307 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=8403307 |accessdate=2012-04-05}}</ref><ref name="pmid7828295">{{cite journal |author=Crozier I, Ikram H, Awan N, Cleland J, Stephen N, Dickstein K, Frey M, Young J, Klinger G, Makris L |title=Losartan in heart failure. Hemodynamic effects and tolerability. Losartan Hemodynamic Study Group |journal=[[Circulation]] |volume=91 |issue=3 |pages=691–7 |year=1995 |month=February |pmid=7828295 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=7828295 |accessdate=2012-04-05}}</ref><ref name="pmid10577995">{{cite journal |author=Riegger GA, Bouzo H, Petr P, Münz J, Spacek R, Pethig H, von Behren V, George M, Arens H |title=Improvement in exercise tolerance and symptoms of congestive heart failure during treatment with candesartan cilexetil. Symptom, Tolerability, Response to Exercise Trial of Candesartan Cilexetil in Heart Failure (STRETCH) Investigators |journal=[[Circulation]] |volume=100 |issue=22 |pages=2224–30 |year=1999 |month=November |pmid=10577995 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10577995 |accessdate=2012-04-05}}</ref><ref name="pmid10955375">{{cite journal |author=Sharma D, Buyse M, Pitt B, Rucinska EJ |title=Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. Losartan Heart Failure Mortality Meta-analysis Study Group |journal=[[The American Journal of Cardiology]] |volume=85 |issue=2 |pages=187–92 |year=2000 |month=January |pmid=10955375 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914999006463 |accessdate=2012-04-05}}</ref><ref name="pmid10477530">{{cite journal |author=McKelvie RS, Yusuf S, Pericak D, Avezum A, Burns RJ, Probstfield J, Tsuyuki RT, White M, Rouleau J, Latini R, Maggioni A, Young J, Pogue J |title=Comparison of candesartan, enalapril, and their combination in congestive heart failure: randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD Pilot Study Investigators |journal=[[Circulation]] |volume=100 |issue=10 |pages=1056–64 |year=1999 |month=September |pmid=10477530 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10477530 |accessdate=2012-04-05}}</ref><ref name="pmid9740480">{{cite journal |author=Mazayev VP, Fomina IG, Kazakov EN, Sulimov VA, Zvereva TV, Lyusov VA, Orlov VA, Olbinskaya LI, Bolshakova TD, Sullivan J, Spormann DO |title=Valsartan in heart failure patients previously untreated with an ACE inhibitor |journal=[[International Journal of Cardiology]] |volume=65 |issue=3 |pages=239–46 |year=1998 |month=August |pmid=9740480 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(98)00149-1 |accessdate=2012-04-05}}</ref><ref name="pmid11759645">{{cite journal |author=Cohn JN, Tognoni G |title=A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure |journal=[[The New England Journal of Medicine]] |volume=345 |issue=23 |pages=1667–75 |year=2001 |month=December |pmid=11759645 |doi=10.1056/NEJMoa010713 |url=http://dx.doi.org/10.1056/NEJMoa010713 |accessdate=2012-04-05}}</ref><ref name="pmid12225725">{{cite journal |author=Wong M, Staszewsky L, Latini R, Barlera S, Volpi A, Chiang YT, Benza RL, Gottlieb SO, Kleemann TD, Rosconi F, Vandervoort PM, Cohn JN |title=Valsartan benefits left ventricular structure and function in heart failure: Val-HeFT echocardiographic study |journal=[[Journal of the American College of Cardiology]] |volume=40 |issue=5 |pages=970–5 |year=2002 |month=September |pmid=12225725 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109702020636 |accessdate=2012-04-05}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
|bgcolor="LemonChiffon"|'''1.''' [[Angiotensin II receptor blockers]] are reasonable to use as alternatives to [[ACEIs|ACE inhibitors]] as first-line therapy for patients with mild to moderate [[heart failure]] and reduced [[left ventricular ejection fraction]] ([[LVEF]]), especially for patients already taking [[Angiotensin II receptor blockers|ARBs]] for other indications.<ref name="pmid14610160">{{cite journal |author=Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Køber L, Maggioni AP, Solomon SD, Swedberg K, Van de Werf F, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM |title=Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both |journal=[[The New England Journal of Medicine]] |volume=349 |issue=20 |pages=1893–906 |year=2003 |month=November |pmid=14610160 |doi=10.1056/NEJMoa032292 |url=http://dx.doi.org/10.1056/NEJMoa032292 |accessdate=2012-04-05}}</ref><ref name="pmid13678870">{{cite journal |author=Granger CB, McMurray JJ, Yusuf S, Held P, Michelson EL, Olofsson B, Ostergren J, Pfeffer MA, Swedberg K |title=Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial |journal=[[Lancet]] |volume=362 |issue=9386 |pages=772–6 |year=2003 |month=September |pmid=13678870 |doi=10.1016/S0140-6736(03)14284-5 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(03)14284-5 |accessdate=2012-04-05}}</ref><ref name="pmid8403307">{{cite journal |author=Gottlieb SS, Dickstein K, Fleck E, Kostis J, Levine TB, LeJemtel T, DeKock M |title=Hemodynamic and neurohormonal effects of the angiotensin II antagonist losartan in patients with congestive heart failure |journal=[[Circulation]] |volume=88 |issue=4 Pt 1 |pages=1602–9 |year=1993 |month=October |pmid=8403307 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=8403307 |accessdate=2012-04-05}}</ref><ref name="pmid7828295">{{cite journal |author=Crozier I, Ikram H, Awan N, Cleland J, Stephen N, Dickstein K, Frey M, Young J, Klinger G, Makris L |title=Losartan in heart failure. Hemodynamic effects and tolerability. Losartan Hemodynamic Study Group |journal=[[Circulation]] |volume=91 |issue=3 |pages=691–7 |year=1995 |month=February |pmid=7828295 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=7828295 |accessdate=2012-04-05}}</ref><ref name="pmid10577995">{{cite journal |author=Riegger GA, Bouzo H, Petr P, Münz J, Spacek R, Pethig H, von Behren V, George M, Arens H |title=Improvement in exercise tolerance and symptoms of congestive heart failure during treatment with candesartan cilexetil. Symptom, Tolerability, Response to Exercise Trial of Candesartan Cilexetil in Heart Failure (STRETCH) Investigators |journal=[[Circulation]] |volume=100 |issue=22 |pages=2224–30 |year=1999 |month=November |pmid=10577995 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10577995 |accessdate=2012-04-05}}</ref><ref name="pmid10955375">{{cite journal |author=Sharma D, Buyse M, Pitt B, Rucinska EJ |title=Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. Losartan Heart Failure Mortality Meta-analysis Study Group |journal=[[The American Journal of Cardiology]] |volume=85 |issue=2 |pages=187–92 |year=2000 |month=January |pmid=10955375 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914999006463 |accessdate=2012-04-05}}</ref><ref name="pmid10477530">{{cite journal |author=McKelvie RS, Yusuf S, Pericak D, Avezum A, Burns RJ, Probstfield J, Tsuyuki RT, White M, Rouleau J, Latini R, Maggioni A, Young J, Pogue J |title=Comparison of candesartan, enalapril, and their combination in congestive heart failure: randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD Pilot Study Investigators |journal=[[Circulation]] |volume=100 |issue=10 |pages=1056–64 |year=1999 |month=September |pmid=10477530 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10477530 |accessdate=2012-04-05}}</ref><ref name="pmid9740480">{{cite journal |author=Mazayev VP, Fomina IG, Kazakov EN, Sulimov VA, Zvereva TV, Lyusov VA, Orlov VA, Olbinskaya LI, Bolshakova TD, Sullivan J, Spormann DO |title=Valsartan in heart failure patients previously untreated with an ACE inhibitor |journal=[[International Journal of Cardiology]] |volume=65 |issue=3 |pages=239–46 |year=1998 |month=August |pmid=9740480 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(98)00149-1 |accessdate=2012-04-05}}</ref><ref name="pmid11759645">{{cite journal |author=Cohn JN, Tognoni G |title=A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure |journal=[[The New England Journal of Medicine]] |volume=345 |issue=23 |pages=1667–75 |year=2001 |month=December |pmid=11759645 |doi=10.1056/NEJMoa010713 |url=http://dx.doi.org/10.1056/NEJMoa010713 |accessdate=2012-04-05}}</ref><ref name="pmid12225725">{{cite journal |author=Wong M, Staszewsky L, Latini R, Barlera S, Volpi A, Chiang YT, Benza RL, Gottlieb SO, Kleemann TD, Rosconi F, Vandervoort PM, Cohn JN |title=Valsartan benefits left ventricular structure and function in heart failure: Val-HeFT echocardiographic study |journal=[[Journal of the American College of Cardiology]] |volume=40 |issue=5 |pages=970–5 |year=2002 |month=September |pmid=12225725 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109702020636 |accessdate=2012-04-05}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
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{|class="wikitable"
{|class="wikitable"
|-
|-
|colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|-
|bgcolor="LightCoral"|'''1.''' Routine combined use of an [[ACEIs|ACE inhibitor]], [[Angiotensin II receptor blockers|ARB]], and [[aldosterone antagonist]] is not recommended for patients with current or prior symptoms of [[heart failure]] and reduced [[left ventricular ejection fraction]] ([[LVEF]]). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|bgcolor="LemonChiffon"|'''1.''' The addition of an [[angiotensin II receptor blockers]] may be considered in persistently symptomatic patients with reduced [[left ventricular ejection fraction]] who are already being treated with conventional therapy. <ref name="pmid14610160">{{cite journal |author=Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Køber L, Maggioni AP, Solomon SD, Swedberg K, Van de Werf F, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM |title=Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both |journal=[[The New England Journal of Medicine]] |volume=349 |issue=20 |pages=1893–906 |year=2003 |month=November |pmid=14610160 |doi=10.1056/NEJMoa032292 |url=http://dx.doi.org/10.1056/NEJMoa032292 |accessdate=2012-04-05}}</ref><ref name="pmid13678870">{{cite journal |author=Granger CB, McMurray JJ, Yusuf S, Held P, Michelson EL, Olofsson B, Ostergren J, Pfeffer MA, Swedberg K |title=Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial |journal=[[Lancet]] |volume=362 |issue=9386 |pages=772–6 |year=2003 |month=September |pmid=13678870 |doi=10.1016/S0140-6736(03)14284-5 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(03)14284-5 |accessdate=2012-04-05}}</ref><ref name="pmid8403307">{{cite journal |author=Gottlieb SS, Dickstein K, Fleck E, Kostis J, Levine TB, LeJemtel T, DeKock M |title=Hemodynamic and neurohormonal effects of the angiotensin II antagonist losartan in patients with congestive heart failure |journal=[[Circulation]] |volume=88 |issue=4 Pt 1 |pages=1602–9 |year=1993 |month=October |pmid=8403307 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=8403307 |accessdate=2012-04-05}}</ref><ref name="pmid7828295">{{cite journal |author=Crozier I, Ikram H, Awan N, Cleland J, Stephen N, Dickstein K, Frey M, Young J, Klinger G, Makris L |title=Losartan in heart failure. Hemodynamic effects and tolerability. Losartan Hemodynamic Study Group |journal=[[Circulation]] |volume=91 |issue=3 |pages=691–7 |year=1995 |month=February |pmid=7828295 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=7828295 |accessdate=2012-04-05}}</ref><ref name="pmid10577995">{{cite journal |author=Riegger GA, Bouzo H, Petr P, Münz J, Spacek R, Pethig H, von Behren V, George M, Arens H |title=Improvement in exercise tolerance and symptoms of congestive heart failure during treatment with candesartan cilexetil. Symptom, Tolerability, Response to Exercise Trial of Candesartan Cilexetil in Heart Failure (STRETCH) Investigators |journal=[[Circulation]] |volume=100 |issue=22 |pages=2224–30 |year=1999 |month=November |pmid=10577995 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10577995 |accessdate=2012-04-05}}</ref><ref name="pmid10955375">{{cite journal |author=Sharma D, Buyse M, Pitt B, Rucinska EJ |title=Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. Losartan Heart Failure Mortality Meta-analysis Study Group |journal=[[The American Journal of Cardiology]] |volume=85 |issue=2 |pages=187–92 |year=2000 |month=January |pmid=10955375 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914999006463 |accessdate=2012-04-05}}</ref><ref name="pmid10477530">{{cite journal |author=McKelvie RS, Yusuf S, Pericak D, Avezum A, Burns RJ, Probstfield J, Tsuyuki RT, White M, Rouleau J, Latini R, Maggioni A, Young J, Pogue J |title=Comparison of candesartan, enalapril, and their combination in congestive heart failure: randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD Pilot Study Investigators |journal=[[Circulation]] |volume=100 |issue=10 |pages=1056–64 |year=1999 |month=September |pmid=10477530 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10477530 |accessdate=2012-04-05}}</ref><ref name="pmid9740480">{{cite journal |author=Mazayev VP, Fomina IG, Kazakov EN, Sulimov VA, Zvereva TV, Lyusov VA, Orlov VA, Olbinskaya LI, Bolshakova TD, Sullivan J, Spormann DO |title=Valsartan in heart failure patients previously untreated with an ACE inhibitor |journal=[[International Journal of Cardiology]] |volume=65 |issue=3 |pages=239–46 |year=1998 |month=August |pmid=9740480 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(98)00149-1 |accessdate=2012-04-05}}</ref><ref name="pmid11759645">{{cite journal |author=Cohn JN, Tognoni G |title=A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure |journal=[[The New England Journal of Medicine]] |volume=345 |issue=23 |pages=1667–75 |year=2001 |month=December |pmid=11759645 |doi=10.1056/NEJMoa010713 |url=http://dx.doi.org/10.1056/NEJMoa010713 |accessdate=2012-04-05}}</ref><ref name="pmid12225725">{{cite journal |author=Wong M, Staszewsky L, Latini R, Barlera S, Volpi A, Chiang YT, Benza RL, Gottlieb SO, Kleemann TD, Rosconi F, Vandervoort PM, Cohn JN |title=Valsartan benefits left ventricular structure and function in heart failure: Val-HeFT echocardiographic study |journal=[[Journal of the American College of Cardiology]] |volume=40 |issue=5 |pages=970–5 |year=2002 |month=September |pmid=12225725 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109702020636 |accessdate=2012-04-05}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
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Revision as of 13:40, 5 October 2012

Congestive Heart Failure Microchapters

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Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Cardiac MRI

Echocardiography

Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies

Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
Positive Inotropics
Anticoagulants
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure angiotensin receptor blockers On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Congestive heart failure angiotensin receptor blockers

CDC on Congestive heart failure angiotensin receptor blockers

Congestive heart failure angiotensin receptor blockers in the news

Blogs on Congestive heart failure angiotensin receptor blockers

Directions to Hospitals Treating Congestive heart failure angiotensin receptor blockers

Risk calculators and risk factors for Congestive heart failure angiotensin receptor blockers

Editor(s)-In-Chief: James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [1] and C. Michael Gibson, M.S., M.D. [2], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [3]

Synonyms and Keywords: Angiotensin II receptor antagonist, Angiotensin receptor blocker, ARB

Indications for an Angiotensin II receptor antagonist

1. The left ventricular ejection fraction (LVEF) is ≤ 40%

or

2. There is a prior history of myocardial infarction (MI)

Background

Dosing

  • ACE-I or ARB therapy should be initiated at low dosage

ACC/AHA Guidelines- Angiotensin II Receptor Blockers Recommendation [3][4]

Class I
1. Angiotensin II receptor blockers are recommended in patients with current or prior symptoms of heart failure and reduced left ventricular ejection fraction (LVEF) who are ACE inhibitor-intolerant.[5][6][7][8][9][10][11][12][13][14][15] (Level of Evidence: A)
Class III (No Benefit)
1. Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is not recommended for patients with current or prior symptoms of heart failure and reduced left ventricular ejection fraction (LVEF). (Level of Evidence: C)
Class IIa
1. Angiotensin II receptor blockers are reasonable to use as alternatives to ACE inhibitors as first-line therapy for patients with mild to moderate heart failure and reduced left ventricular ejection fraction (LVEF), especially for patients already taking ARBs for other indications.[5][6][7][8][9][10][11][12][13][14] (Level of Evidence: A)
Class IIb
1. The addition of an angiotensin II receptor blockers may be considered in persistently symptomatic patients with reduced left ventricular ejection fraction who are already being treated with conventional therapy. [5][6][7][8][9][10][11][12][13][14] (Level of Evidence: B)

Vote on and Suggest Revisions to the Current Guidelines

Guidelines Resources

References

  1. ↑ Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, Yusuf S, Pocock S (2003). "Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme". Lancet. 362 (9386): 759–66. PMID 13678868. Retrieved 2012-04-03. Unknown parameter |month= ignored (help)
  2. ↑ Young JB, Dunlap ME, Pfeffer MA, Probstfield JL, Cohen-Solal A, Dietz R, Granger CB, Hradec J, Kuch J, McKelvie RS, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, Held P, Solomon SD, Yusuf S, Swedberg K (2004). "Mortality and morbidity reduction with Candesartan in patients with chronic heart failure and left ventricular systolic dysfunction: results of the CHARM low-left ventricular ejection fraction trials". Circulation. 110 (17): 2618–26. doi:10.1161/01.CIR.0000146819.43235.A9. PMID 15492298. Retrieved 2012-04-03. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
  4. ↑ 4.0 4.1 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
  5. ↑ 5.0 5.1 5.2 Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Køber L, Maggioni AP, Solomon SD, Swedberg K, Van de Werf F, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM (2003). "Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both". The New England Journal of Medicine. 349 (20): 1893–906. doi:10.1056/NEJMoa032292. PMID 14610160. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  6. ↑ 6.0 6.1 6.2 Granger CB, McMurray JJ, Yusuf S, Held P, Michelson EL, Olofsson B, Ostergren J, Pfeffer MA, Swedberg K (2003). "Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial". Lancet. 362 (9386): 772–6. doi:10.1016/S0140-6736(03)14284-5. PMID 13678870. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  7. ↑ 7.0 7.1 7.2 Gottlieb SS, Dickstein K, Fleck E, Kostis J, Levine TB, LeJemtel T, DeKock M (1993). "Hemodynamic and neurohormonal effects of the angiotensin II antagonist losartan in patients with congestive heart failure". Circulation. 88 (4 Pt 1): 1602–9. PMID 8403307. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  8. ↑ 8.0 8.1 8.2 Crozier I, Ikram H, Awan N, Cleland J, Stephen N, Dickstein K, Frey M, Young J, Klinger G, Makris L (1995). "Losartan in heart failure. Hemodynamic effects and tolerability. Losartan Hemodynamic Study Group". Circulation. 91 (3): 691–7. PMID 7828295. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  9. ↑ 9.0 9.1 9.2 Riegger GA, Bouzo H, Petr P, Münz J, Spacek R, Pethig H, von Behren V, George M, Arens H (1999). "Improvement in exercise tolerance and symptoms of congestive heart failure during treatment with candesartan cilexetil. Symptom, Tolerability, Response to Exercise Trial of Candesartan Cilexetil in Heart Failure (STRETCH) Investigators". Circulation. 100 (22): 2224–30. PMID 10577995. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  10. ↑ 10.0 10.1 10.2 Sharma D, Buyse M, Pitt B, Rucinska EJ (2000). "Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. Losartan Heart Failure Mortality Meta-analysis Study Group". The American Journal of Cardiology. 85 (2): 187–92. PMID 10955375. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  11. ↑ 11.0 11.1 11.2 McKelvie RS, Yusuf S, Pericak D, Avezum A, Burns RJ, Probstfield J, Tsuyuki RT, White M, Rouleau J, Latini R, Maggioni A, Young J, Pogue J (1999). "Comparison of candesartan, enalapril, and their combination in congestive heart failure: randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD Pilot Study Investigators". Circulation. 100 (10): 1056–64. PMID 10477530. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  12. ↑ 12.0 12.1 12.2 Mazayev VP, Fomina IG, Kazakov EN, Sulimov VA, Zvereva TV, Lyusov VA, Orlov VA, Olbinskaya LI, Bolshakova TD, Sullivan J, Spormann DO (1998). "Valsartan in heart failure patients previously untreated with an ACE inhibitor". International Journal of Cardiology. 65 (3): 239–46. PMID 9740480. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  13. ↑ 13.0 13.1 13.2 Cohn JN, Tognoni G (2001). "A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure". The New England Journal of Medicine. 345 (23): 1667–75. doi:10.1056/NEJMoa010713. PMID 11759645. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  14. ↑ 14.0 14.1 14.2 Wong M, Staszewsky L, Latini R, Barlera S, Volpi A, Chiang YT, Benza RL, Gottlieb SO, Kleemann TD, Rosconi F, Vandervoort PM, Cohn JN (2002). "Valsartan benefits left ventricular structure and function in heart failure: Val-HeFT echocardiographic study". Journal of the American College of Cardiology. 40 (5): 970–5. PMID 12225725. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  15. ↑ McMurray JJ, Ostergren J, Swedberg K, Granger CB, Held P, Michelson EL, Olofsson B, Yusuf S, Pfeffer MA (2003). "Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial". Lancet. 362 (9386): 767–71. doi:10.1016/S0140-6736(03)14283-3. PMID 13678869. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)


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