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Supportive Care in Heart Failure$
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James Beattie and Sarah Goodlin

Print publication date: 2008

Print ISBN-13: 9780198570288

Published to Oxford Scholarship Online: November 2011

DOI: 10.1093/acprof:oso/9780198570288.001.0001

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Heart Failure—Optimal Pharmacological Therapy

Heart Failure—Optimal Pharmacological Therapy

(p.49) Chapter 4 Heart Failure—Optimal Pharmacological Therapy
Supportive Care in Heart Failure

J.Paul Rocchiccioli

John J. V. Mcmurray

Oxford University Press

This chapter addresses the state of knowledge in the evidence-based management of heart failure (HF) with medications. Diuretics were amongst the first therapies to be used in the treatment of HF. Angiotensin-converting enzyme (ACE) inhibitors are considered the first-line therapy in the management of HF with reduced left-ventricular systolic function. Angiotensin receptor blockers (ARBs) are the most recent class of drugs to be shown to be of benefit in HF. β-Blockers are considered the greatest advance in the treatment of HF since ACE inhibitors and lead to a further substantial reduction in mortality and morbidity. The mechanisms of action, clinical benefits, adverse effects and interactions, and practical uses of these therapies are reported. In addition, the mechanisms of action, clinical benefits, adverse effects and interactions, and practical uses of aldosterone antagonists, hydralazine and isosorbide dinitrate, and cardiac glycosides are described. It also explores the HF with preserved ejection fraction and other pharmacological therapies. Despite the impressive therapeutic armamentarium, patients with HF continue to experience progressive symptoms and shorter life expectancy.

Keywords:   heart failure, pharmacological therapy, diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, aldosterone antagonists, hydralazine and isosorbide dinitrate, cardiac glycosides

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