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One of the best tools to help practitioners make the best bedside clinical decisions when managing patients with acute cardiovascular disease.
A comprehensive guidelines implementation toolkit especially for Nurses & Allied Professionals.
Dr. Roberto Martín Asenjo
Prof. Hector Bueno ,
Dr. Michael Mcintosh
ACE inhibitors and ARBs act by blocking RAAS with beneficial effects on patients with cardiovascular risk factors only (hypertension, diabetes) and with several heart diseases (heart failure, coronary artery disease). When indicated, they should be started at low dose and increased gradually to reach the target dose. ACE inhibitors and ARBs share indications, contraindications and most side effects (except cough, more frequent with ACE inhibtors). Monitoring of the renal function and serum potassium is needed to reduce the incidence of renal insufficiency and hyperkalaemia during treatment, particularly when initiated or uptitrated.
The activation of the renin-angiotensin-aldosterone system (RAAS) plays a key role in the development and progression of cardiovascular disease, especially in arterial hypertension, heart failure and coronary artery disease. ACE inhibitors are the most used and studied type of RAAS blocker and their benefits are due to their neurohormonal modulatory effects, which have vasodilatory, anti-inflammatory, plaque-stabilizing, antithrombotic and anti-proliferative effects.
ARBs have similar pharmacological properties to ACE inhibitors but may be better tolerated as coughing is not a frequent adverse effect. As ARBs are more expensive and have not shown any additional clinical benefits over ACE inhibitors, they are usually considered as an alternative for ACE inhibitors intolerant patients.
ACE inhibitors and ARBs share most indications and contraindications:
De Sutter J, Mendes M, Franco OH. Chapter 19 Cardioprotective drugs. In: Gielen S, De Backer G, Piepoli MF, Wood D, editors. The ESC Textbook of Preventive Cardiology. 2nd ed. United Kingdom: Oxford University Press, 2016.
Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Eur Heart J 2016; 37: 2315–2381.
De Lorenzo A. Chapter 8: Drugs used in acute cardiovascular care. In: Bueno H, Vrancks P, Bonnefoy E. The ACVC Clinical Decision-Making Toolkit.
The ESC Prevention of Cardiovascular Disease programme is supported by AMGEN, AstraZeneca, Ferrer, and Sanofi and Regeneron in the form of educational grants.
Our mission: To reduce the burden of cardiovascular disease.
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