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Mitsunami, Kenichi; Inoue, Shuhei; Maeda, Keiko; Endoh, Shigeru; Takahashi, Masayuki; Okada, Mamoru; Sugihara, Hideki; Kinoshita, Masahiko

doi:10.1023/a:1007754100351

Cited by 36 publications

(2 citation statements)

References 19 publications

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“…These effects are essential for the regression of LV hypertrophy, and the improvement in the elastic properties of the myocardium [50, 51]. Several trials have documented that LV hypertrophy is more effectively reduced by ACE inhibitors than by any other antihypertensive drugs, suggesting an effect on myocardial structure beyond that provided by the reduction of pressure overload.…”

Section: Management Of Diastolic Dysfunctionmentioning

confidence: 99%

Diastolic Heart Failure: A Concise Review

Aziz¹

2013

J Clin Med Res

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The concept of “diastolic” heart failure grew out of the observation that many patients who have the symptoms and signs of heart failure had an apparently normal left ventricular (LV) ejection fraction. Thus it was assumed that since systolic function was “preserved” the problem must lie in diastole, although it is not clear by whom or when this assumption was made. Nevertheless, many guidelines followed on how to diagnose “diastolic” heart failure backed up by indicators of diastolic dysfunction derived from Doppler echoardiography. Diastolic heart failure is associated with a lower annual mortality rate of approximately 8% as compared to annual mortality of 19% in heart failure with systolic dysfunction, however, morbidity rate can be substantial. Thus, diastolic heart failure is an important clinical disorder mainly seen in the elderly patients with hypertensive heart disease. Early recognition and appropriate therapy of diastolic dysfunction is advisable to prevent further progression to diastolic heart failure and death. There is no specific therapy to improve LV diastolic function directly. Medical therapy of diastolic dysfunction is often empirical and lacks clear-cut pathophysiologic concepts. Nevertheless, there is growing evidence that calcium channel blockers, beta-blockers, ACE-inhibitors and ARB as well as nitric oxide donors can be beneficial. Treatment of the underlying disease is currently the most important therapeutic approach.

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Section: Management Of Diastolic Dysfunctionmentioning

confidence: 99%

Diastolic Heart Failure: A Concise Review

Aziz¹

2013

J Clin Med Res

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“…Optimizing hemodynamics is primarily achieved through reduction of cardiac preload and afterload. ACE inhibitors and ARBs directly affect myocardial relaxation and compliance by blocking angiotensin II receptors, thereby reducing interstitial collagen deposition and fibrosis [17, 18]. ACE inhibitors have shown to cause regression of LV hypertrophy, decrease blood pressure, and prevent or modify cardiac remodeling; these findings support the use of ACE inhibitors in HFNEF patients [19, Class III].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Heart Failure With Normal Ejection Fraction

Hamdani

Paulus

2010

Curr Treat Options Cardio Med

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Opinion StatementHeart failure (HF) is a major cause of mortality and morbidity and one of the most frequent reasons for hospital admission in the United States and Europe. Currently, more than 50% of HF patients have a normal (N) left ventricular (LV) ejection fraction (EF) (LVEF >50%). The main pathophysiologic processes involved in HFNEF are increased LV stiffness and abnormal relaxation, resulting in impaired LV filling. Hypertension and myocardial ischemia are the most common causes of HFNEF. Precipitating factors include volume overload, tachycardia, physical exercise, systemic stressors (such as fever and infection), arrhythmia, increased salt intake, and use of nonsteroidal anti-inflammatory drugs. There is little evidence to guide treatment, as previously HFNEF patients have been excluded from clinical trials on the basis of a normal LVEF. Survival improved over time in patients with reduced (R) EF (HFREF) (LVEF <40%), reflecting the beneficial effects of treatment in this phenotype. However, survival did not improve for HFNEF patients. The approach to the treatment of HFNEF patients should focus on reducing LV filling pressure, controlling hypertension, modifying ischemia, and improving LV relaxation. Therefore, diuretics are suitable for HFNEF patients to reduce ventricular filling pressure. Hypertension can be treated by using multiple agents if necessary. Drugs of particular interest and recommended to treat hypertension are calcium channel blockers (CCBs) and antagonists of the renin-angiotensin-aldosterone system, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and aldosterone antagonists. Ischemic heart disease can be treated with antiplatelet therapy, anticoagulants, and β-blockers. Heart rate control in atrial fibrillation can be achieved with β-blockers and digoxin. Finally, ACE inhibitors and ARBs could potentially decrease LV hypertrophy in hypertensive patients with HFNEF.

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Angiotensin II Receptor Blockers

Grossman¹,

Messerli²,

Neutel³

2000

Arch Intern Med

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Background: The incidence of hypertension in the pediatric population has been increasing. Childhood blood pressure is predictive of adult BP. The renin angiotensin aldosterone system pathway is important in the mediation of pediatric hypertension. New therapies approved for adults are often used off label in children with little or no efficacy and safety data in the paediatric population The angiotensin receptor blockers has been shown to be effective and safe in the treatment of pediatric hypertension.Objective: The objective of this review is to highlight available clinical evidence on the efficacy, safety tolerability and kinetics of angiotensin receptor blockers in childhood hypertension and its antiproteinuric effect in renal disease. Method: The search strategy was based on Pubmed, Medline database, Cochrane Library, manual, Google and Yahoo searches. We summarized ten randomized controlled trials (RCTs .The search was done in June 2014 and updated in January and May 2015 in English language . Results: A total of 120 publications were accessed from which 68 references were included in the review. The design and outcome of ten key randomised trials are summarised. Randomised trials have demonstrated the efficacy of angiotensin receptor blockers in the pediatric population aged 1-16 years. This class of drugs reduce blood pressures in pediatric patients with hypertension and proteinuria in renal disease. Safety pharmacokinetic, dosage, and palatability of adult formulations for the paediatric age group are highlighted Conclusion: Angiotensin receptor antagonists are useful effective and safe alternatives to available antihypertensive therapy in paediatric population. Angiotensin receptor antagonists should however be prescribed cautiously for sexually active adolescent females due to concern about angiotensin receptor blocker fetopathy.

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Cited by 36 publications

References 19 publications

Diastolic Heart Failure: A Concise Review

Diastolic Heart Failure: A Concise Review

Treatment of Heart Failure With Normal Ejection Fraction

Angiotensin II Receptor Blockers

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