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From digoxin to angiotensin-converting enzyme inhibitors: issues in pharmacotherapy for congestive heart failure
1Georgetown University, Washington, DC, USA. hackenbh@hotmail.com
Insights
Congestive heart failure (CHF) treatment has evolved. Angiotensin-converting enzyme (ACE) inhibitors are increasingly favored over older digoxin for improving survival rates in CHF patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) presents significant mortality and rising prevalence in the US.
- Treatment strategies for CHF have advanced with evolving pathophysiologic understanding.
- Digoxin was an early CHF treatment, but its efficacy remains debated.
Purpose of the Study:
- To review the current pathophysiology of CHF.
- To examine the rationale for using digoxin and ACE inhibitors in CHF pharmacotherapy.
- To discuss future challenges in CHF pharmacotherapy.
Main Methods:
- Literature review of CHF pathophysiology.
- Analysis of clinical evidence for digoxin and ACE inhibitors.
- Discussion of pharmacologic treatment evolution.
Main Results:
- ACE inhibitors represent a newer class of drugs for CHF.
- ACE inhibitors were the first drug class demonstrated to improve survival in CHF patients.
- ACE inhibitors are gaining favor over digoxin in current CHF treatment approaches.
Conclusions:
- The pharmacologic management of CHF is dynamic.
- ACE inhibitors offer survival benefits in CHF, contrasting with ongoing digoxin efficacy debates.
- Future research should address remaining challenges in CHF pharmacotherapy.
Abstract:
Congestive heart failure (CHF) is a disease with high mortality rates and increasing prevalence in the United States. As our understanding of the pathophysiologic characteristics of this disease has progressed, so has our pharmacologic approach to treatment. Digoxin was the first documented drug used in the treatment of CHF, and since that time, the efficacy of its use has been the source of great controversy. A more recent treatment option is the use of angiotensin-converting enzyme (ACE) inhibitors, the first drug class shown to increase survival rates in CHF. Although controversy remains, ACE inhibitors appear to be gaining favor over digoxin in the pharmacologic approach to treatment. This article provides a pathophysiologic review of CHF as it is understood today, the rationale behind the use of digoxin and ACE inhibitors, and a challenge for the future in the pharmacotherapy of CHF.