Related Experiment Video

Updated: Mar 15, 2026

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
08:35

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Published on: May 26, 2022

4.4K

Treatment with Optimal Dose Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Has a Positive

Luis Sargento1, Andre Vicente Simões2, Susana Longo3

  • 1Heart Failure Unit, Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Alameda Linhas de Torres, 1769-001, Lisboa, Portugal. luisjosesargento@gmail.com.

Drugs & Aging
|August 29, 2016
PubMed

Insights

Optimizing angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) dosage in older adults with heart failure with reduced ejection fraction (HFrEF) improves long-term survival. Higher doses are associated with better outcomes in this population.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Heart failure with reduced ejection fraction (HFrEF) predominantly affects older individuals.
  • Optimal dosing strategies for ACEIs/ARBs in elderly HFrEF patients remain unclear.
  • Understanding dose-response relationships is crucial for improving survival in this demographic.

Purpose of the Study:

  • To investigate the association between ACEI/ARB dose levels and long-term survival.
  • To evaluate outcomes in stable, older outpatients (>70 years) and octogenarians with HFrEF.
  • To determine if higher ACEI/ARB doses correlate with improved survival rates.

Main Methods:

  • A 3-year follow-up study of 138 clinically stable outpatients with HFrEF (LVEF <40%).
  • Patients were categorized by ACEI/ARB dose: none, low (1-50% target), and high (50-100% target).
  • Cox regression survival models were employed, adjusting for age, ischemic etiology, and renal function.

Main Results:

  • 91.3% of patients received ACEIs/ARBs, with 52.9% on high doses.
  • Survival significantly improved with increasing ACEI/ARB dose across all evaluated groups (total, >70 years, octogenarians).
  • High-dose ACEI/ARB therapy demonstrated superior survival benefits compared to low-dose therapy in the overall population.

Conclusions:

  • Achieving optimal doses of ACEIs/ARBs in older ambulatory HFrEF patients is linked to enhanced long-term survival.
  • The findings support dose optimization of ACEIs/ARBs as a key strategy in managing elderly HFrEF patients.
  • Further research may refine target doses for specific elderly subgroups.
Abstract

More Related Videos

A Modified Two Kidney One Clip Mouse Model of Renin Regulation in Renal Artery Stenosis08:21

A Modified Two Kidney One Clip Mouse Model of Renin Regulation in Renal Artery Stenosis

Published on: October 26, 2020

5.7K
Ascending Aortic Constriction in Rats for Creation of Pressure Overload Cardiac Hypertrophy Model10:18

Ascending Aortic Constriction in Rats for Creation of Pressure Overload Cardiac Hypertrophy Model

Published on: June 29, 2014

17.7K

Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
1.4K
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
465
Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors01:30

Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors

Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
2.8K
Heart Failure Drugs: &#946;-Blockers01:22

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
1.1K
Antihypertensive Drugs: Angiotensin II Receptor Blockers01:30

Antihypertensive Drugs: Angiotensin II Receptor Blockers

In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
3.0K
Antihypertensive Drugs: Direct Renin Inhibitors01:25

Antihypertensive Drugs: Direct Renin Inhibitors

The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
1.7K