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Angiotensin receptor blocker therapy for heart failure patients: is combination treatment a feasible prospect?

P A Mehta1, S McDonagh, J Phillips

  • 1Clinical Cardiology, National Heart and Lung Institute, Imperial College, London, United Kingdom. p.mehta@imperial.ac.uk

Clinical Cardiology
|September 11, 2009
PubMed

Insights

Combination therapy with angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) is not feasible for most heart failure patients due to ineligibility and intolerance issues.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Angiotensin II receptor blockers (ARBs) combined with angiotensin-converting enzyme inhibitors (ACEIs) show improved outcomes in heart failure.
  • However, tolerability and excessive neurohormonal inhibition are concerns with combination therapy.

Purpose of the Study:

  • To assess the eligibility and tolerance of combination therapy with candesartan (an ARB) plus ACEIs in general heart failure patients.
  • To determine the feasibility of this combination in a real-world clinical setting.

Main Methods:

  • Prospective evaluation of 115 heart failure patients for eligibility and tolerance to candesartan plus ACEI.
  • Patients were assessed for achievement of optimal ACEI doses, symptoms, and prior ARB use.

Main Results:

  • 95% of patients were ineligible for candesartan initiation.
  • Common reasons for ineligibility included inability to reach optimal ACEI doses (77%), asymptomatic status (29%), and hypotension (20%).
  • Of the 5% eligible, three patients failed candesartan titration due to hyperkalemia.

Conclusions:

  • Combination therapy with ARBs and ACEIs is not feasible for the majority of general heart failure patients.
  • High rates of ineligibility and intolerance limit the practical application of this treatment strategy.
Abstract

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