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Are angiotensin II receptor blockers indicated in chronic heart failure?

Correspondence to:
Correspondence to:
Professor Michel Komajda, Service de Cardiologie, Hôpital Pitié-Salpétrière, 47-83 Boulevard de l'hôpital, 75651 Paris Cedex 13, France;
michel.komajda@psl.ap-hop-paris.fr

Keywords: angiotensin coverting enzyme inhibitor; angiotensin II receptor blocker; heart failure

Abbreviations: ACE-I, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker; CHARM, candesarton in heart failure—assessment of reduction in mortality and morbidity; ELITE, evaluation of losartan in the elderly; NYHA, New York Heart Association; OPTIMAAL, optimal trial in myocardial infarction with the angiotensin II antagonist losartan; RENAAL, reduction of end points in NIDDM with the angiotensin II antagonist losartan; VALIANT, valsartan in acute myocardial infarction trial; Val-HeFT, valsartan heart failure trial

Chronic heart failure is one of the most serious cardiac problems encountered in clinical practice. Modulation of the renin angiotensin system is a key element in the treatment of this syndrome. There is overwhelming evidence in favour of the benefit of angiotensin converting enzyme (ACE) inhibitors on morbidity and mortality in mild to severe heart failure and in heart failure or left ventricular dysfunction following acute myocardial infarction.¹ It is not known, however, whether the benefit of ACE inhibition is solely attributable to blockade of angiotensin II production or also related to bradykinin accumulation.² Moreover, bradykinin accumulation has been implicated in the adverse effects observed with ACE inhibitors such a cough and might result in prejunctional noradrenaline (norepinephrine) release.³

The development of orally active, non-peptide angiotensin II type I receptor blockers (ARBs) has raised hopes for a new generation of modulators of the renin angiotensin system better tolerated and potentially . . . [Full text of this article]

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