Angiotensin-Converting Enzyme Inhibitors or β-Blockers in Heart Failure

Fang, James C.

doi:10.1161/circulationaha.105.586545

Cited by 20 publications

(4 citation statements)

References 26 publications

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“…Interestingly, our data suggest better efficacy of beta‐blockers in HF prevention in comparison with ACE‐I. Studies and review papers suggest that the order of the therapy in chronic HF might be important for future prognosis 26–28 . It is postulated that the adrenergic system is activated earlier in HF than the renin‐angiotensin system, 20 and since the adrenergic system is a potent stimulator of the renin‐angiotensin system, beta‐adrenergic response blockade prior to ACE inhibition might be more beneficial.…”

Section: Discussionmentioning

confidence: 79%

Efficacy of Medical Therapy for the Reduction of Heart Failure Events in Patients with Implanted Cardioverter Defibrillators

Pietrasik

Goldenberg

McNitt

et al. 2009

Cardiovasc electrophysiol

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Efficacy of Medical Therapy for the Reduction of HF Events. Background: Prophylactic therapy with the implantable cardioverter defibrillator (ICD) reduces the mortality among patients with left ventricular dysfunction; however, life-prolonging device therapy has been shown to be associated with an increased risk for subsequent heart failure (HF) events. There are limited data on the effect of the primary types of HF medications, angiotensin converting enzyme inhibitors (ACE-I), and beta-blockers on HF progression in ICD-treated patients. Methods: Multivariate Cox proportional hazards regression analysis was used to assess the effect of time-dependent medical therapy with ACE-I and beta-blockers on the development of HF in patients with an ICD in the Multicenter Automatic Defibrillator Trail (MADIT) II.Results: In multivariate analysis, ICD therapy was associated with a significant 39% increase in the risk of HF as compared with conventional medical therapy. ACE-I and beta-blockers exhibited a graded efficacy for the reduction in the risk of HF events in ICD-treated patients: the greatest risk reduction of HF was seen in patients taking combination therapy (HR = 0.36, P < 0.001), followed by patients using beta-blockers only (HR = 0.51, P = 0.017) and ACE-I only (HR = 0.64, P = 0.071). Beta-blocker subtypes (metoprolol [HR = 0.49, P = 0.001] and carvedilol [HR = 0.58, P = 0.004]) exhibited similar efficacy. Consistent results were demonstrated when the combined endpoint of HF or death was assessed.Conclusions: ICD-treated patients experience an increased risk for HF events that can be significantly attenuated by medical therapy with beta-blockers and ACE-

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Section: Discussionmentioning

confidence: 79%

Efficacy of Medical Therapy for the Reduction of Heart Failure Events in Patients with Implanted Cardioverter Defibrillators

Pietrasik

Goldenberg

McNitt

et al. 2009

Cardiovasc electrophysiol

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“…Questions remain on the optimal timing and order of initiation of hemodynamically active agents. 25 It is not known, for example, whether a strategy of low-dose combination ACEI, β-blocker, and mineralocorticoid receptor antagonist would be superior to high-dose ACEI alone in patients with borderline blood pressure or renal function. Recently, it has been suggested that a precision approach for titrating doses could be an alternative to high-dose targeting.…”

Section: Discussionmentioning

confidence: 99%

Dose of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers and Outcomes in Heart Failure

Khan

Fonarow

Ahmed

et al. 2017

Circ: Heart Failure

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BACKGROUND:The association between angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) doses on outcomes in patients with heart failure (HF) with reduced ejection fraction is uncertain. The objective of this study was to investigate the effect of dose of ACEI and ARBs on outcomes and drug discontinuation in patients with HF with reduced ejection fraction. METHODS AND RESULTS:MEDLINE, Ovid SP, and Embase were searched from the inception of these databases till August 2016. Randomized controlled trials that compared high doses of ACEI or ARB against low doses among patients with HF with reduced ejection fraction were included. Pooled analysis was done using a random-effects model, and quality of the studies was assessed by JADAD scale. The main outcomes were all-cause mortality and drug discontinuation. A total of 6 studies (4841 patients in low-dose and 4330 patients in highdose groups) were included. Compared with low dose, high-dose ACEI or ARBs decreased all-cause mortality modestly (relative risk, 0.94; 95% confidence interval (CI), 0. CONCLUSIONS:In patients with HF with reduced ejection fraction, compared with lower doses, higher doses of ACEI and ARB significantly though modestly improved the composite end point of all-cause mortality or HF hospitalization without significantly increasing the chances of discontinuation.

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“…BB and ACEI or ARB are known to be beneficial in patients with heart failure with reduced ejection fraction by reducing activation of the sympathetic nervous system and renin-angiotensin-aldosterone system, respectively, which when chronically activated have a negative impact on cardiac function. 9,10 PICM is a result of the left ventricular dyssynchrony that is produced by RV pacing and usually in the presence of underlying risk factors for cardiomyopathy. 4 In a healthy conduction system, all regions of the ventricle are depolarized simultaneously to produce a synchronized contraction.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Medical Therapy on Reducing the Risk of Pacing Induced Cardiomyopathy

Agha,

Schaich,

Rikhi

et al. 2024

Preprint

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BackgroundHigh right ventricular (RV) pacing burden can result in pacing-induced cardiomyopathy (PICM).ObjectivesTo investigate whether ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), and beta blockers (BB) reduce the risk of PICM in patients with high RV pacing burden.MethodsThis was a single center, retrospective study which included patients with normal ejection fraction (EF) and complete heart block who underwent pacemaker implantation between 1992 and 2013. The medical therapy group included patients who received ACEI/ARB, BB, or combination of these classes. The control group received neither ACEI/ARB nor BB. The primary endpoint was PICM, defined as upgrade to a biventricular device or reduction in EF to ≤40% without another etiology identified. Fine-Gray subdistribution hazard models accounting for death as a competing risk were used to determine the relationship between medical therapy (ACEI/ARB, BB, or combination) and cumulative incidence of PICM.ResultsThe study included 642 patients (mean [SD] age 71 [14] years; 51% women). Over 10 years of follow-up, 76 (11.8%) patients received ACEI/ARB therapy only; 49 (7.6%) received BB therapy only; and 86 (13.4%) were exposed to both. PICM occurred in 10 of 211 patients in the medical therapy group (4.7%) and in 30 of 431 in the control group (7.0%). In adjusted analyses weighted for group-switching, the risk of PICM was significantly lower in the medical therapy group compared to the control group (HR 0.59, 95% CI 0.45 – 0.77). Patients exposed to combination therapy had the lowest risk (HR 0.46, 95% CI 0.31 – 0.69).ConclusionIn patients with high RV pacing burden, BB therapy alone or in combination with ACEI/ARBs appears to reduce the risk of PICM within 10 years of pacemaker implantation.

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Angiotensin-Converting Enzyme Inhibitors or β-Blockers in Heart Failure

Cited by 20 publications

References 26 publications

Efficacy of Medical Therapy for the Reduction of Heart Failure Events in Patients with Implanted Cardioverter Defibrillators

Efficacy of Medical Therapy for the Reduction of Heart Failure Events in Patients with Implanted Cardioverter Defibrillators

Dose of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers and Outcomes in Heart Failure

The Effect of Medical Therapy on Reducing the Risk of Pacing Induced Cardiomyopathy

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