Angiotensin-converting enzyme inhibitors, angiotensin II receptors antagonists, beta-blockers and ivabradine as supportive therapy in pulmonary hypertension: Drug safety and tolerability

Correale, Michele; Zicchino, Stefano; Monaco, Ilenia; Brunetti, Natale Daniele

doi:10.1016/j.ejim.2017.07.016

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…As mentioned above, inhibition of fibrogenesis might contribute to the anti-arrhythmic effect. Furthermore, reducing abnormal wall stretch of the ventricle by decreasing the preload and afterload of the RV might also lessen the risk of VA events (34)(35)(36). Stabilization of electrolyte concentration and prolonged action potential might also promote the anti-arrhythmic effect as suggested by other study (37).…”

Section: Discussionmentioning

confidence: 89%

Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers: Anti-arrhythmic Drug for Arrhythmogenic Right Ventricular Cardiomyopathy

Zheng

et al. 2021

Front. Cardiovasc. Med.

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Background: Current treatment guidelines for arrhythmogenic right ventricular cardiomyopathy (ARVC) mainly emphasize on prevention of ventricular arrhythmic events. Despite the progressive nature of ARVC, therapeutic options focusing on decelerating disease progression are scarce.Methods and Results: This retrospective observational cohort study included 311 patients [age, 39.1 ± 14.4 years; male, 233 (74.9%)] with a definite diagnosis of ARVC as determined by the 2010 Task Force Diagnostic Criteria. Among them, 113 patients (36.3%) received ACEI/ARB treatment. Disease progression was evaluated according to repeat transthoracic echocardiograms with a linear mixed model. Patients receiving ACEI/ARB treatment were associated with slower disease progression reflected by a gradual decrease in tricuspid annular plane systolic excursion than those not receiving ACEI/ARB treatment (0.37 vs. 0.61 mm per year decrease, P < 0.001) and slower dilation of right ventricular outflow tract (0.57 vs. 1.06 mm per year increased, P = 0.003). Cox proportional hazard regression models were used to evaluate the association between life-threatening ventricular tachycardia events and ACEI/ARB treatment. A reduced risk of life-threatening ventricular arrhythmia was associated with ACEI/ARB treatment compared to that without ACEI/ARB treatment (adjusted HR: 0.71, 95% CI: 0.52–0.96, P = 0.031).Conclusions: ACEI/ARB treatment is associated with slower disease progression and lower risk of life-threatening ventricular arrhythmia in patients with ARVC. Delaying disease progression may pave way for reducing life-threatening ventricular arrhythmia risk.

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Section: Discussionmentioning

confidence: 89%

Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers: Anti-arrhythmic Drug for Arrhythmogenic Right Ventricular Cardiomyopathy

Zheng

et al. 2021

Front. Cardiovasc. Med.

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“…Pulmonary vascular remodeling is mitigated by treatment with angiotensin receptor antagonists (ARBs) ( 6 ). Angiotensin-converting enzyme inhibitor (ACEI) or ARB treatment demonstrated favorable safety and tolerability profiles in patients with PAH, and these individuals also experienced lower rates of HF re-hospitalization ( 7 ). To counteract the negative consequences of aberrant RAAS activation, the body releases a group of vasoactive peptides known as natriuretic peptides (NP) ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

The emerging role of sacubitril/valsartan in pulmonary hypertension with heart failure

Yang

Hui

et al. 2023

Front. Cardiovasc. Med.

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Pulmonary hypertension due to left heart disease (PH-LHD) represents approximately 65%–80% of all patients with PH. The progression, prognosis, and mortality of individuals with left heart failure (LHF) are significantly influenced by PH and right ventricular (RV) dysfunction. Consequently, cardiologists should devote ample attention to the interplay between HF and PH. Patients with PH and HF may not receive optimal benefits from the therapeutic effects of prostaglandins, endothelin receptor antagonists, or phosphodiesterase inhibitors, which are specific drugs for pulmonary arterial hypertension (PAH). Sacubitril/valsartan, the angiotensin receptor II blocker-neprilysin inhibitor (ARNI), was recommended as the first-line therapy for patients with heart failure with reduced ejection fraction (HFrEF) by the 2021 European Society of Cardiology Guidelines. Although ARNI is effective in treating left ventricular (LV) enlargement and lower ejection fraction, its efficacy in treating individuals with PH and HF remains underexplored. Considering its vasodilatory effect at the pre-capillary level and a natriuretic drainage role at the post-capillary level, ARNI is believed to have a broad range of potential applications in treating PH-LHD. This review discusses the fundamental pathophysiological connections between PH and HF, emphasizing the latest research and potential benefits of ARNI in PH with various types of LHF and RV dysfunction.

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“…Thus, ivabradine demonstrates beneficial effects in animal models of PH and RV hypertrophy and failure (4,15), as well as in patients with PH as supportive treatment to the basic therapy (13,14).…”

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confidence: 99%

“…Recently published data demonstrate that HR reduction by ivabradine as supportive treatment to the well-established therapy in patients with PH led to improvement of cardiac function, 6 minute walking distance, NYHA functional class(13) and even reduced re-hospitalization for worsening HF(14).Thereafter, Gomez and co-authors demonstrated that HR reduction by ivabradine improves RV filling and biventricular hemodynamics through the realignment of right ventricularleft ventricular cardiac cycle events and improves interventricular interactions in monocfrotalineinduced PH in rats (15). In the current issue of the American Journal of Respiratory Cell and Molecular Biology, Ishii and co-authors greatly extended these data and describe the effect of ivrabradine on RV function in three comprehensive animal models of PH and RV hypertrophy and failure (4).…”

mentioning

confidence: 99%

Heart Rate Reduction by Ivabradine: Slowly but Surely?

Kojonazarov

2020

Am J Respir Cell Mol Biol

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Angiotensin-converting enzyme inhibitors, angiotensin II receptors antagonists, beta-blockers and ivabradine as supportive therapy in pulmonary hypertension: Drug safety and tolerability

Cited by 4 publications

References 24 publications

Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers: Anti-arrhythmic Drug for Arrhythmogenic Right Ventricular Cardiomyopathy

Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers: Anti-arrhythmic Drug for Arrhythmogenic Right Ventricular Cardiomyopathy

The emerging role of sacubitril/valsartan in pulmonary hypertension with heart failure

Heart Rate Reduction by Ivabradine: Slowly but Surely?

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