The Use of Angiotensin-II Receptor Blockers in Heart Failure

Angiotensin-II receptor blockers (ARBs) have recently been evaluated in large trials to determine their role in the treatment of heart failure. It is clear that angiotensin-converting enzyme inhibitors (ACE-Is) prevent the effects of an overactive renin-angiotensin aldosterone system and therefore prevent disease progression. Despite this evidence, intolerance (eg, cough) limits the use of ACE-Is in heart failure patients. Improved tolerability makes ARBs attractive alternatives in patients intolerant to ACE-Is. ARBs are also hypothesized to have additional benefits when used in combination with ACE-Is through more complete inhibition of angiotensin-II. However, studies of ARBs in patients with heart failure have not confirmed this hypothesis. This article describes the rationale and evaluates the literature for the use of ARBs in heart failure.