Inotropic Drugs and Neurohormonal Antagonists in the Treatment of HF in the Elderly

O’Connor, Christopher M.; Arumugham, Pradeep

doi:10.1016/j.cger.2006.09.001

Cited by 1 publication

(1 citation statement)

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“…This observation has been supported by early meta-analysis evaluation that indicated ACE inhibitors to be more efficacious than b-adrenergic receptor anatagonists and diuretics in decreasing left ventricular mass index [69]. In this regard, ACE inhibitors are considered the firstline therapy for patients with hypertension and concomitant heart failure [67,70,71]. Klingbeil et al [72] found left ventricular mass index reductions of 13% with ARBs, 11% with calcium channel antagonists, 10% with ACE inhibitors, 8 % with diuretics, and 6% with b-adrenergic antagonists.…”

Section: Hypertension and Heart Failure In Elderly Patientsmentioning

confidence: 94%

Pathways involved in the transition from hypertension to hypertrophy to heart failure. Treatment strategies

2007

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The renin-angiotensin-aldosterone system (RAAS) is critical in regulating systemic blood pressure, water and electrolyte balance, and pituitary gland hormones. These physiologies appear to be primarily mediated by the angiotensin II/AT(1) receptor subtype system. Overstimulation of this system can predispose cardiovascular disease (CVD) characterized by excessive vasoconstriction, fibrosis, and cardiac remodeling. If untreated, the patient typically displays a continuum of pathophysiologic conditions progressing from atherosclerosis to left ventricle hypertrophy (LVH), coronary thrombosis, myocardial infarcts, with heart failure as an endpoint. Intervention with antihypertensive therapy is necessary to inhibit this progression. RAAS blocking drugs appear to be the most effective approach. Diastolic heart failure patients benefit from treatment with angiotensin converting enzyme (ACE) inhibitors and angiotensin AT(1) receptor blockers (ARBs). Elderly CVD patients evidence age-related changes in body composition that alter the distribution and half-life of medications, thus presenting special challenges to treatment. The presence of comorbidities such as diabetes, renal dysfunction, liver insufficiency further complicates any therapeutic strategy. In addition, noncompliance because of cognitive impairment, depression, confusion due to the complexity of dose regimens, and lack of an appropriate social support system can disrupt positive outcome. The present review discusses the roles of an overactive RAAS and sympathetic nervous system as primary contributors to CVD. In addition, treatment strategies are discussed, focusing on middle aged and elderly hypertensive and heart failure patients.

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