Foundations of Pharmacotherapy for Heart Failure With Reduced Ejection Fraction

Abstract

Pharmacologic treatment for systolic heart failure, otherwise known as heart failure with reduced ejection fraction, has been established through clinical trials and is formulated into guidelines to standardize the diagnosis and treatment. The premise of pharmacologic therapy in heart failure with reduced ejection fraction is aimed primarily at interrupting the neurohormonal cascade that is responsible for altering left ventricular shape and function. This is the first in a series of articles to describe the pharmacologic agents in the guidelines that impact the morbidity and mortality associated with heart failure. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and vasodilators will be presented in the context of the mechanism of action in heart failure, investigational trials that showed beneficial effects, and the practical application for clinical use.

Effects of neurohormonal antagonists on blood pressure in patients with heart failure with reduced ejection fraction (HFrEF): a systematic review protocol

“…The mainstay of pharmacological treatment for HFrEF is neurohormonal blockade with the aim to limit disease progression, improve symptoms and quality of life, and reduce mortality [12]. The neurohormonal antagonist drugs used for the treatment of patients with HFrEF include well-established drugs like angiotensin-converting enzyme inhibitors (ACEi) [angiotensin receptor blockers (ARB) if an ACEi is not tolerated], beta blockers (BB), mineralocorticoid receptor antagonists (MRA), and the more recent angiotensin receptor neprilysin inhibitor (ARNI) [13][14][15]. Other disease-modifying drugs that have shown benefit in HFrEF include hydralazine and isosorbide dinitrate combination, I f -channel blocker, and dapagliflozin [16][17][18].…”