JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
 QUICK SEARCH:   [advanced]


     


J Am Coll Cardiol, 1999; 33:1163-1173
© 1999 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Brunner-La Rocca, H. P.
Right arrow Articles by Esler, M. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Brunner-La Rocca, H. P.
Right arrow Articles by Esler, M. D.

REVIEW ARTICLES

Recent insight into therapy of congestive heart failure: focus on ACE inhibition and angiotensin-II antagonism

Hans Peter Brunner-La Rocca, MDa,1, Gautam Vaddadia and Murray D. Esler, MBBS, PhD, FRACPa

a Baker Medical Research Institute, Melbourne, 8008, Australia

Manuscript received August 12, 1998; revised manuscript received November 23, 1998, accepted January 5, 1999.

Reprint requests and correspondence: Dr. Hans Peter Brunner-La Rocca, Baker Medical Research Institute, PO Box 6492, Melbourne 8008, Victoria, Australia

One possible intervention to interrupt the deleterious effects of the renin-angiotensin system is suppression of angiotensin II (Ang II) formation by inhibition of angiotensin-converting enzyme (ACE). However, ACE inhibition incompletely suppresses Ang II formation and also leads to accumulation of bradykinin. Angiotensin II type 1 (AT1) receptors are believed to promote the known deleterious effects of Ang II. Therefore, AT1 receptor antagonists have been recently introduced into therapy for hypertension and congestive heart failure (CHF). Although there are significant differences between the effects of AT1 receptor antagonists and ACE inhibitors including the unopposed stimulation of angiotensin II type 2 (AT2) receptors by AT1 receptor antagonists, the discussion of whether ACE inhibitors, AT1 receptor antagonists or the combination of both are superior in the pharmacotherapy of CHF is still largely theoretical. Accordingly, AT1 receptor antagonists are still investigational. Angiotensin-converting enzyme inhibitors remain first line therapy in patients with CHF due to systolic dysfunction. However, in patients not able to tolerate ACE inhibitor induced side effects, in particular cough, AT1 receptor antagonism is a good alternative. In clinical practice, emphasis should be placed on increasing the utilization of ACE inhibitors, as more than 50% of patients with CHF do not receive ACE inhibitors. In addition, the majority of those on ACE inhibitors receive doses lower than the dosage used in the large clinical trials. Although not yet completely proved, it is likely that high doses of ACE inhibition are superior to low doses with respect to prognosis and symptoms.

Abbreviations and Acronyms
  ACE = angiotensin-converting enzyme
  Ang = angiotensin
  AT1 = angiotensin II type 1
  AT2 = angiotensin II type 2
  B1 = bradykinin type 1
  B2 = bradykinin type 2
  CHF = congestive heart failure
  MCP-1 = monocyte chemoattractant protein-1
  PAI-1 = plasminogen activator inhibitor C-1
  RAS = renin angiotensin system
  t-PA = tissue plasminogen activator




This article has been cited by other articles:


Home page
JNMHome page
V. Dilsizian, W. C. Eckelman, M. L. Loredo, E. M. Jagoda, and J. Shirani
Evidence for Tissue Angiotensin-Converting Enzyme in Explanted Hearts of Ischemic Cardiomyopathy Using Targeted Radiotracer Technique
J. Nucl. Med., February 1, 2007; 48(2): 182 - 187.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
D. Jin, S. Takai, M. Yamada, M. Sakaguchi, K. Kamoshita, K. Ishida, Y. Sukenaga, and M. Miyazaki
Impact of chymase inhibitor on cardiac function and survival after myocardial infarction
Cardiovasc Res, November 1, 2003; 60(2): 413 - 420.
[Abstract] [Full Text] [PDF]


Home page
EndocrinologyHome page
N. Takahashi, J. R. Hagaman, H.-S. Kim, and O. Smithies
Minireview: Computer Simulations of Blood Pressure Regulation by the Renin-Angiotensin System
Endocrinology, June 1, 2003; 144(6): 2184 - 2190.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
P. Jong, C. Demers, R. S. McKelvie, and P. P. Liu
Angiotensin receptor blockers in heart failure: meta-analysis of randomized controlled trials
J. Am. Coll. Cardiol., February 6, 2002; 39(3): 463 - 470.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
S. Lee, C. M. Kramer, S. Mankad, S.-e. Yoo, and K. Sandberg
Combined angiotensin converting enzyme inhibition and angiotensin AT1 receptor blockade up-regulates myocardial AT2 receptors in remodeled myocardium post-infarction
Cardiovasc Res, July 1, 2001; 51(1): 131 - 139.
[Abstract] [Full Text] [PDF]


Home page
Journal of Renin-Angiotensin-Aldosterone SystemHome page
M. S Weinberg, A. J Weinberg, and D. H Zappe
Effectively targetting the renin-angiotensin-aldosterone system in cardiovascular and renal disease: rationale for using angiotensin II receptor blockers in combination with angiotensin-converting enzyme inhibitors
Journal of Renin-Angiotensin-Aldosterone System, September 1, 2000; 1(3): 217 - 233.
[PDF]




HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 1999 by the American College of Cardiology Foundation.