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Published on: October 3, 2019
Therapeutic strategies and neurohormonal control in heart failure
1Cardiovascular Research Foundation, Rotterdam, The Netherlands.
Insights
Neurohormonal activation significantly impacts heart failure progression and treatment. New therapies aim to modulate these neuroendocrine changes for better heart failure management.
Area of Science:
- Cardiology
- Pharmacology
- Endocrinology
Background:
- Neurohormonal activation is a key factor in heart failure (HF) progression, prognosis, and therapeutic response.
- Vasopressor and growth-promoting systems are emphasized, but atrial natriuretic factor (ANF) and N-terminal proANF show prognostic value even early in HF.
- Current HF therapy is shifting from improving cardiac function to modulating neuroendocrine changes.
Purpose of the Study:
- To review the role of neurohormonal activation in heart failure.
- To discuss current and novel pharmacological approaches to modulate neurohormonal activation in HF.
- To highlight the need for careful consideration of established therapies that may worsen neuroendocrine stimulation.
Main Methods:
- Literature review of neurohormonal activation in heart failure.
- Analysis of the impact of various hormonal systems on HF progression and prognosis.
- Evaluation of existing and emerging pharmacological interventions targeting neurohormonal pathways.
Main Results:
- Neurohormonal systems play a critical role in the transition to end-stage heart failure and influence prognosis.
- Novel therapeutic strategies include angiotensin receptor antagonists, dopaminergic stimulation, neutral endopeptidase inhibition, aldosterone antagonism, and beta-blockade.
- Digitalis glycosides may also modulate neurohormonal activity.
- Some established HF treatments might exacerbate neuroendocrine stimulation, necessitating co-administration of modulating therapies.
Conclusions:
- Modulating neurohormonal activation is a crucial therapeutic strategy in heart failure management.
- A range of novel pharmacological agents are being developed to target these pathways.
- Integrated therapeutic approaches combining cardiac support with neuroendocrine modulation are essential for optimal heart failure care.
Abstract:
Neurohormonal activation is one of the major determining factors in the process of transition from asymptomatic ventricular dysfunction to end-stage heart failure, in the prognosis of heart failure, and in the efficacy and, hence, choice and timing of pharmacological therapy. Although various counteracting hormonal systems are involved, emphasis in terms of functionality is on vasopressor and growth-promoting systems. In contrast, ANF and N-terminal proANF probably have a significant prognostic value, even at an early stage. The focus of heart failure therapy is moving from measures aimed at improving cardiac function to ones that concentrate on modulating neuroendocrine changes during failure and their effects on intrinsic peripheral and cardiac alterations. Although ACE inhibition undoubtedly constitutes a major step forward in this approach, alternative ways to modulate neurohormonal activation pharmacologically are needed. Several such novel approaches are being developed, including angiotensin receptor antagonists, dopaminergic stimulation, neutral endopeptidase inhibition, aldosterone antagonism and beta blockade. In addition to their positive inotropic properties digitalis glycosides may act as neurohormonal modulators. Finally, the realization that several well-established forms of heart failure therapy may aggravate neuroendocrine stimulation demands careful consideration as to whether such agents are really necessary, and underlines the desirability of co-administering neurohormonal modulating therapy.
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