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[Inhibition of renin-angiotensin-aldosterone system in heart failure, or from CONSENSUS to PARADIGM-HF]

Jiří Vítovec, Jindřich Špinar, Lenka Špinarová

    Vnitrni Lekarstvi
    |June 16, 2015
    PubMed

    Insights

    Angiotensin-aldosterone system inhibitors, including ACE inhibitors and ARBs, are standard treatments for chronic heart failure. New dual inhibitors show promise for future heart failure therapy.

    Area of Science:

    • Cardiology
    • Pharmacology
    • Clinical Trials

    Background:

    • Chronic heart failure (CHF) management has evolved significantly with advancements in understanding the renin-angiotensin-aldosterone system (RAAS).
    • RAAS inhibition has become a cornerstone in treating patients with CHF, aiming to improve mortality and morbidity.

    Purpose of the Study:

    • To provide a historical overview of mortality trials focusing on RAAS inhibition in chronic heart failure.
    • To evaluate the efficacy of different classes of RAAS inhibitors and novel therapeutic agents.

    Main Methods:

    • Historical survey of landmark mortality trials in chronic heart failure.
    • Analysis of data from trials including CONSENSUS, SOLVD, RENAAL, and PARADIGM-HF.
    • Review of pharmacological agents targeting the RAAS, including ACE inhibitors, ARBs, mineralocorticoid receptor blockers, direct renin inhibitors, and neprilysin inhibitors.

    Main Results:

    • ACE inhibitors and Angiotensin II Receptor Blockers (ARBs), alongside mineralocorticoid receptor blockers, have been established as the gold standard in CHF treatment.
    • Direct renin inhibitor aliskiren and the dual blocker enalapril plus neprilysin demonstrated ineffectiveness in improving mortality outcomes.
    • The novel dual inhibitor valsartan plus neprilysin (LCZ 696) emerged as a promising therapeutic agent.

    Conclusions:

    • Established RAAS inhibitors remain crucial for chronic heart failure management.
    • Novel therapeutic strategies, such as dual inhibition with valsartan and neprilysin, represent a significant advancement in heart failure treatment.
    • Continued research into effective pharmacological interventions is vital for improving outcomes in patients with chronic heart failure.

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