Latest pharmaceutical approaches across the spectrum of heart failure

Abstract

Despite major advances in prevention and medical therapy, heart failure (HF) remains associated with high morbidity and mortality, especially in older and frailer patients. Therefore, a complete, guideline-based treatment is essential, even in HF patients with conditions traditionally associated with a problematic initiation and escalation of the medical HF therapy, such as chronic kidney disease and arterial hypotension, as the potential adverse effects are overcome by the overall decrease of the absolute risk. Furthermore, since the latest data suggest that the benefit of a combined medical therapy (MRA, ARNI, SGLT2i, beta-blocker) may extend up to a LVEF of 65%, further trials on these subgroups of patients (HFmrEF, HFpEF) are needed to re-evaluate the guideline-directed medical therapy across the HF spectrum. In particular, the use of SGLT2i was recently extended to HFpEF patients, as evidenced by the DELIVER and EMPEROR-preserved trials. Moreover, the indication for other conservative treatments in HF patients, such as the intravenous iron supplementation, was accordingly strengthened in the latest guidelines. Finally, the possible implementation of newer substances, such as finerenone, in guideline-directed medical practice for HF is anticipated with great interest.

3-Nitroatenolol: First Synthesis, Chiral Resolution and Enantiomers’ Absolute Configuration

“…Yellow oil (0.475 g, 29%). 1 H NMR (700 MHz, CD 3 OD): δ 7.86 (d, J = 2.1 Hz, 1H), 7.56 (dd, J = 8.6, 2.2 Hz, 1H), 7.26 (d, J = 8.6 Hz; 1H), 4.30-4.24 (m, 2H), 4.19-4.17 (m, 1H), 3.55 (s, 2H, -CH 2 CO-), 3.50-3.43 (m, 1H, -CH(CH 3 ) 2 ), 3.33-3.24 (m, 2H, -CH 2 NH-), 1.39 (d, J = 2.8 Hz, 3H, -CH 3 ), 1.37 (d, J = 2.8 Hz, 3H, -CH 3 ). 13 C NMR (175 MHz, CD 3 OD): δ 175.8, 151.9, 140.8 (-CNO 2 ), 136.5, 130.6, 127.2, 116.2, 72.5 (-CH 2 O-), 66.4 (-CHOH), 52.2 (-CH(CH 3 ) 2 ), 48.5 (-CH 2 NH-), 41.5 (-CH 2 CO-), 19.3 (-CH 3 ), 18.8 (-CH 3 ).…”

“…β-blockers are a commonly prescribed medication for cardiovascular conditions such as heart failure [1] and to prevent major adverse cardiac events following myocardial infarction [2]. The use of β-blockers for the treatment of angina pectoris was pioneered by Scottish pharmacologist Sir James Black in 1958, for which he was awarded the Nobel Prize [3].…”

Pharmacological stimulation of the parasympathetic system – a promising means of cardioprotection in heart failure

“…-It would be exciting to consider whether donepezil exerts an additional benefit if added on top of currently recommended HF treatment, including SGLT2 inhibition, as there is restricted space for further improvement. -Currently, only SGLT2 inhibitors are recommended as a treatment of HF with preserved ejection fraction [14]. Donepezil, with its anti-remodelling, antioxidant, and anti-inflammatory action, could be investigated in this indication.…”