Topics:
Heart Failure (HF)
Session number: 24
Session title: Optimising RAAS blockade in heart failure
Authors: Zannad, Faiez (Dommartin les Toul, FR)
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Since RALES and EPHESUS the use of aldosterone blockers in heart failure has been increasing steadily and more so than that of angiotensin receptor blockers as a third agent on top of ACE inhibitors and betablockers. Over 50% of patients admitted with acute heart failure take an aldosterone blocker. However, no evidence of the benefit of aldosterone blockers in light to moderate heart failure has been proven. Safety issues may have been over-emphasized. But, indeed, conditions of unsafe use of aldosterone blockers must be reminded in order to make the best use of these agents.
Insights from recent trials with a number of subgroup analyses and substudy resluts will be presented as well as an update on ongoing trials with aldosterone blockers (TOPCAT, EMPHASIS-HF)
The pharmacology of new agents acting on the aldosterone pathway will be discussed
Teaching objective of the lecture:
Learn how to use optimally aldosterone blockers
Discuss the mechanisms of action on the heart, the vessel and the kidney of aldosterone blockers
Identify benefits and safety of aldosterone blockers
Learn about new aldosterone blocker agents entering clinical development
Take home messages:
- aldosterone blockers are beneficial in a number of high risk patient population
- aldosterone blockers should be used with caution in patients with renal dysfunction
- The mechanisms of action of aldosterone blockers go far beyond their effect on Na K exchange and involve beneficial effects on heart and vessel remodelling, fibrosis and inflammation.
The content of this article reflects the personal opinion of the
author/s and is not necessarily the official position of the
European Society of Cardiology.