Pharmacologic Options for the Management of Systolic Heart Failure: Examining Underlying Mechanisms

• The optimal management of systolic heart failure includes combination therapy to influence myocardial remodelling favourably by affecting neurohormonal activation and underlying maladaptive pathophysiological pathways. These medications include modulators of the renin-angiotensin-aldosterone system (eg, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists) and β-adrenergic receptor blockers. In addition, an agent with a distinct and complementary mechanism of bradycardic action, the selective pacemaker-current (If) inhibitor ivabradine, provides further reduction of heart rate. Also, a new drug that incorporates neprilysin inhibition combined with angiotensin receptor blockade shows incremental effectiveness. The primary goal of this review is to provide a mechanistic explanation of the complementary role of therapeutic interventions in modulating pathways leading to progressive systolic heart failure. A secondary goal is to summarize the key findings of the pivotal clinical trials that have demonstrated the efficacy of these agents in this population. © 2015 Canadian Cardiovascular Society.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

angiotensin receptor

angiotensin receptor antagonist

beta adrenergic receptor blocking agent

dipeptidyl carboxypeptidase inhibitor

ivabradine

membrane metalloendopeptidase

clinical trial (topic)

disease course

drug efficacy

drug mechanism

evidence based medicine

human

intervention study

renin angiotensin aldosterone system

Review

systolic heart failure

Publikations- och innehållstyp

ref (ämneskategori)

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