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
Overview
Indications for Angiotensin II Receptor Antagonist Use
1. The left ventricular ejection fraction (LVEF) is ≤ 40%
or
2. There is a prior history of myocardial infarction (MI)
Background
- ACE-I or ARB therapy is recommended for ANY patient with reduced left ventricular ejection fraction (≤ 40%) regardless of the etiology of left ventricular systolic dysfunction (ischemic or nonischemic) or presence/absence of symptoms. Patients with or without heart failure (in other words, even those with asymptomatic left ventricular systolic dysfunction) are included in this recommendation.
- In addition, ACE-I or ARB therapy is indicated for patients with history of myocardial infarction whether or not left ventricular systolic dysfunction or heart failure is present.
- ACE-I or ARB therapy is also recommended for patients who are at high risk for the development of heart failure due to the presence of coronary, cerebrovascular, or peripheral vascular disease.
- ARBs are reserved for patients who are intolerant of ACE-Is for reasons (such as persistent cough) OTHER than hyperkalemia, progression of chronic kidney disease/worsening azotemia, or hypotension caused by prior ACE-I therapy. If a patient experiences hyperkalemia, worsening azotemia, or hypotension as a result of ACE-I therapy, the same is likely to result from ARB therapy. In the CHARM study candesartan reduced both hospitalization and mortality.[1][2]
Dosing
2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) [3][4]
Angiotensin II Receptor Blockers in Patients Presenting With Heart Failure (DO NOT EDIT) [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) " |
Related Chapters
Sources
- The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult [3]
- 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 [4]
References
- ↑ 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) - ↑ 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) - ↑ 3.0 3.1 3.2 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
- ↑ 4.0 4.1 4.2 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
- ↑ 5.0 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) - ↑ 6.0 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) - ↑ 7.0 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) - ↑ 8.0 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) - ↑ 9.0 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) - ↑ 10.0 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) - ↑ 11.0 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) - ↑ 12.0 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) - ↑ 13.0 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) - ↑ 14.0 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) - ↑ 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)