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Heart failure: New data do not SUPPORT triple RAAS blockade

A H Jan Danser1, Anton H van den Meiracker1

  • 1Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Room EE1418b, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, Netherlands.

Nature Reviews. Nephrology
|March 25, 2015
PubMed

Insights

Adding olmesartan to standard heart failure medications worsened kidney function and increased cardiac events and mortality in hypertensive patients. This triple blockade of the renin-angiotensin-aldosterone system proved detrimental.

Area of Science:

  • Cardiology
  • Pharmacology
  • Nephrology

Background:

  • Chronic stable heart failure (HF) management often involves renin-angiotensin-aldosterone system (RAAS) inhibitors.
  • Optimizing RAAS blockade is a key therapeutic goal in HF management.

Purpose of the Study:

  • To investigate the efficacy and safety of adding olmesartan (angiotensin-receptor blocker) to existing therapies in hypertensive patients with chronic stable heart failure.

Main Methods:

  • The study involved hypertensive patients with chronic stable heart failure.
  • Participants received a combination of angiotensin-converting-enzyme inhibitors and beta-blockers.
  • Olmesartan was added to this regimen to create a triple RAAS blockade.

Main Results:

  • Triple RAAS blockade with olmesartan was associated with adverse outcomes.
  • Worsening of renal function was observed in the treatment group.
  • There was a significant increase in cardiac events and mortality.

Conclusions:

  • Triple blockade of the RAAS using olmesartan in combination with ACE inhibitors and beta-blockers is not beneficial for hypertensive patients with chronic stable heart failure.
  • This therapeutic strategy carries increased risks of renal impairment and adverse cardiovascular events.

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