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Heart failure treatment: what role for ARBs? (News You Can Use).

Article Excerpt
Heart failure (HF), the most common Medicare diagnosis-related group, has a significant and growing impact on health care resources. The incidence of HF has tripled during the last decade. Almost 5 million Americans have HF, and an estimated 500,000 new cases are diagnosed yearly. The lifetime risk of HF is about 20%. (1) Drug therapy has improved considerably in recent years, but the magnitude and severity of the problem has created a need for newer therapies--particularly since HF is associated with an increased risk of sudden death and a diminished quality of life. (2)

THE ROLE OF ANGIOTENSIN II

In chronic HF, activation of neurohormonal mechanisms promotes maladaptive growth, remodeling, and progressive myocardial dysfunction. Angiotensin II is a potent vasoconstrictor and growth-stimulating hormone that may contribute to impairment of left ventricular (LV) function and progression of HF through such mechanisms as:

* Increased impedance of LV emptying.

* Adverse long-term structural effects on the heart and vasculature.

* Potentially harmful activation of other neurohormonal agonists, such as epinephrine, aldosterone, and endothelin.

RECENT TRIAL RESULTS

Physiologically active levels of angiotensin II persist despite long-term therapy with angiotensin-converting enzyme (ACE) in hibitors....

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