Val-HeFT: do angiotensin-receptor blockers benefit heart failure patients already receiving ACE inhibitor therapy?

2005 ◽  
Vol 2 (3) ◽  
pp. 128-129 ◽  
Author(s):  
John JV McMurray
Keyword(s):  
Heart Failure ◽  
Ace Inhibitor ◽  
Angiotensin Receptor Blockers ◽  
Inhibitor Therapy ◽  
Angiotensin Receptor ◽  
Heart Failure Patients ◽  
Receptor Blockers

scholarly journals Management of Heart Failure Patient with CKD

2021 ◽  
pp. CJN.14180920
Author(s):  
Debasish Banerjee ◽  
Giuseppe Rosano ◽  
Charles A. Herzog
Keyword(s):  
Heart Failure ◽  
Angiotensin Receptor Blockers ◽  
Inhibitor Therapy ◽  
High Dose ◽  
Evidence Based ◽  
Angiotensin Receptor ◽  
Sodium Glucose Cotransporter ◽  
Ckd Stage ◽  
Patients With Heart Failure ◽  
Receptor Blockers

CKD is common in patients with heart failure, associated with high mortality and morbidity, which is even higher in people undergoing long-term dialysis. Despite increasing use of evidence-based drug and device therapy in patients with heart failure in the general population, patients with CKD have not benefitted. This review discusses prevalence and evidence of kidney replacement, device, and drug therapies for heart failure in CKD. Evidence for treatment with β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, and sodium-glucose cotransporter inhibitors in mild-to-moderate CKD has emerged from general population studies in patients with heart failure with reduced ejection fraction (HFrEF). β-Blockers have been shown to improve outcomes in patients with HFrEF in all stages of CKD, including patients on dialysis. However, studies of HFrEF selected patients with creatinine <2.5 mg/dl for ACE inhibitors, <3.0 mg/dl for angiotensin-receptor blockers, and <2.5 mg/dl for mineralocorticoid receptor antagonists, excluding patients with severe CKD. Angiotensin receptor neprilysin inhibitor therapy was successfully used in randomized trials in patients with eGFR as low as 20 ml/min per 1.73 m2. Hence, the benefits of renin-angiotensin-aldosterone axis inhibitor therapy in patients with mild-to-moderate CKD have been demonstrated, yet such therapy is not used in all suitable patients because of fear of hyperkalemia and worsening kidney function. Sodium-glucose cotransporter inhibitor therapy improved mortality and hospitalization in patients with HFrEF and CKD stages 3 and 4 (eGFR>20 ml/min per 1.73 m2). High-dose and combination diuretic therapy, often necessary, may be complicated with worsening kidney function and electrolyte imbalances, but has been used successfully in patients with CKD stages 3 and 4. Intravenous iron improved symptoms in patients with heart failure and CKD stage 3; and high-dose iron reduced heart failure hospitalizations by 44% in patients on dialysis. Cardiac resynchronization therapy reduced death and hospitalizations in patients with heart failure and CKD stage 3. Peritoneal dialysis in patients with symptomatic fluid overload improved symptoms and prevented hospital admissions. Evidence suggests that combined cardiology-nephrology clinics may help improve management of patients with HFrEF and CKD. A multidisciplinary approach may be necessary for implementation of evidence-based therapy.

scholarly journals Penerapan DASH (Dietary Approach to Stop Hypertension) pada Penderita Hipertensi

2019 ◽  
Vol 14 (2) ◽  
pp. 17-22
Author(s):  
Bagas Mukti
Keyword(s):  
Calcium Channel ◽  
Randomized Controlled Trials ◽  
Ace Inhibitor ◽  
Channel Blocker ◽  
Angiotensin Receptor Blockers ◽  
Controlled Trials ◽  
Angiotensin Receptor ◽  
Randomized Controlled ◽  
Receptor Blockers ◽  
Β Blocker

Hipertensi merupakan suatu manifestasi dari gangguan hemodinamik kardiovaskular yang penyebabnya multifactor. Prevalensi penderita hipertensi di Indonesia sendiri pada tahun 2018 meningkatkan dari tahun 2013 dan peningkatan tersebut sebesar 8,3 %. Seseorang dikatakan hipertensi jika tekanan darah diatas atau sama dengan 140/90 mmHg dan harus persisten. Hipertensi sendiri masih menjadi penyebab kematian tertinggi dan dapat menyebabkan komplikasi yang serius seperti stroke, penyakit jantung iskemik, gagal ginjal, retinopati dan sebagainya. Ada banyak guidelines yang menjelaskan bagaimana manajemen terapi untuk mengurangi tekanan darah tinggi. Ada dua cara untuk mentatalaksana penderita hipertensi, yaitu dengan terapi farmakologis (Diuretik, β-blocker, ACE Inhibitor, Angiotensin Receptor Blockers (ARB), Calcium-channel blocker (CCB) dan sebagainya) dan terapi non farmakologi dengan memodifikasi gaya hidup seperti olahraga teratur, mengurangi konsumsi alcohol, menghentikan rokok, serta menurunkan berat badan, mengurangi konsumsi garam dengan cara mengadaptasi diet DASH (Dietary Approaches to Stop Hypertension). Diet DASH menerapkan pola makan yang kaya akan sayuran, buah-buahan, susu dan produk-produk susu tanpa lemak atau rendah lemak, biji-bijian, ikan, unggas, kacang-kacangan dan diet ini juga mengandung sedikit natrium, makanan manis, gula, lemak, dan daging merah. Pada penelitian meta-analisis dan sistematik review dari randomized controlled trials (RCTs), mengungkapkan bahwa penerapan diet DASH pada pasien hipertensi dapat menurunkan tekanan darah sistolik sebesar 6,74 mmHg dan tekanan darah diastolic sebesar 3,54 mmHg. Studi meta-analisis lain dari RCTs membuktikan bahwa dengan penerapan diet ini dapat menurunkan berat badan pada pasien yang mengalami obesitas sebesar 1,42 kg dalam waktu 8-24 minggu. Sehingga diet DASH ini sangat bermanfaat untuk diterapkan pada pasien hipertensi.

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