Coronary heart disease secondary prevention renin-angiotensin-aldosterone system blockers: Difference between revisions
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<nowiki>"</nowiki>'''1.''' ACE inhibitors should be started and continued indefinitely in all patients with left ventricular ejection fraction ≤40% and in those with hypertension, diabetes, or chronic kidney disease, unless contraindicated. <ref name="pmid7654275">{{cite journal |author=Garg R, Yusuf S |title=Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials |journal=JAMA |volume=273 |issue=18 |pages=1450–6 |year=1995 |month=May |pmid=7654275 |doi= |url=}}</ref><ref name="pmid10639539">{{cite journal |author=Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G |title=Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators |journal=N. Engl. J. Med. |volume=342 |issue=3 |pages=145–53 |year=2000 |month=January |pmid=10639539 |doi=10.1056/NEJM200001203420301 |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: A'']])<nowiki>"</nowiki> | <nowiki>"</nowiki>'''1.''' [[ACE inhibitors]] should be started and continued indefinitely in all patients with left ventricular ejection fraction]] ≤40% and in those with [[hypertension]], [[diabetes]], or [[chronic kidney disease]], unless contraindicated. <ref name="pmid7654275">{{cite journal |author=Garg R, Yusuf S |title=Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials |journal=JAMA |volume=273 |issue=18 |pages=1450–6 |year=1995 |month=May |pmid=7654275 |doi= |url=}}</ref><ref name="pmid10639539">{{cite journal |author=Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G |title=Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators |journal=N. Engl. J. Med. |volume=342 |issue=3 |pages=145–53 |year=2000 |month=January |pmid=10639539 |doi=10.1056/NEJM200001203420301 |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: A'']])<nowiki>"</nowiki> | ||
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<nowiki>"</nowiki>'''1.''' It is reasonable to use ACE inhibitors in all other patients. <ref name="pmid13678872">{{cite journal |author=Fox KM |title=Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study) |journal=Lancet |volume=362 |issue=9386 |pages=782–8 |year=2003 |month=September |pmid=13678872 |doi= |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']]) | <nowiki>"</nowiki>'''1.''' It is reasonable to use [[ACE inhibitors]] in all other patients. <ref name="pmid13678872">{{cite journal |author=Fox KM |title=Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study) |journal=Lancet |volume=362 |issue=9386 |pages=782–8 |year=2003 |month=September |pmid=13678872 |doi= |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']]) | ||
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<nowiki>"</nowiki>'''1.''' The use of ARBs is recommended in patients who have heart failure or who have had a myocardial infarction with left ventricular | <nowiki>"</nowiki>'''1.''' The use of [[ARBs]] is recommended in patients who have [[heart failure]] or who have had a [[myocardial infarction]] with [[left ventricular ejection fraction]] ≤40% and who are [[ACE-inhibitor]] intolerant. <ref name="pmid10821361">{{cite journal |author=Pitt B, Poole-Wilson PA, Segal R, ''et al.'' |title=Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial--the Losartan Heart Failure Survival Study ELITE II |journal=Lancet |volume=355 |issue=9215 |pages=1582–7 |year=2000 |month=May |pmid=10821361 |doi= |url=}}</ref><ref name="pmid13678868">{{cite journal |author=Pfeffer MA, Swedberg K, Granger CB, ''et al.'' |title=Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme |journal=Lancet |volume=362 |issue=9386 |pages=759–66 |year=2003 |month=September |pmid=13678868 |doi= |url=}}</ref><ref name="pmid14610160">{{cite journal |author=Pfeffer MA, McMurray JJ, Velazquez EJ, ''et al.'' |title=Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both |journal=N. Engl. J. Med. |volume=349 |issue=20 |pages=1893–906 |year=2003 |month=November |pmid=14610160 |doi=10.1056/NEJMoa032292 |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: A'']])<nowiki>"</nowiki> | ||
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<nowiki>"</nowiki>'''1.''' It is reasonable to use ARBs in other patients who are ACE-inhibitor intolerant. <ref name="pmid18757085">{{cite journal |author=Yusuf S, Teo K, Anderson C, ''et al.'' |title=Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial |journal=Lancet |volume=372 |issue=9644 |pages=1174–83 |year=2008 |month=September |pmid=18757085 |doi=10.1016/S0140-6736(08)61242-8 |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']]) | <nowiki>"</nowiki>'''1.''' It is reasonable to use [[ARBs]] in other patients who are [[ACE-inhibitor]] intolerant. <ref name="pmid18757085">{{cite journal |author=Yusuf S, Teo K, Anderson C, ''et al.'' |title=Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial |journal=Lancet |volume=372 |issue=9644 |pages=1174–83 |year=2008 |month=September |pmid=18757085 |doi=10.1016/S0140-6736(08)61242-8 |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']]) | ||
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<nowiki>"</nowiki>'''1.''' The use of ARBs in combination with an ACE inhibitor is not well established in those with systolic heart failure. <ref name="pmid14610160">{{cite journal |author=Pfeffer MA, McMurray JJ, Velazquez EJ, ''et al.'' |title=Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both |journal=N. Engl. J. Med. |volume=349 |issue=20 |pages=1893–906 |year=2003 |month=November |pmid=14610160 |doi=10.1056/NEJMoa032292 |url=}}</ref><ref name="pmid18378520">{{cite journal |author=Yusuf S, Teo KK, Pogue J, ''et al.'' |title=Telmisartan, ramipril, or both in patients at high risk for vascular events |journal=N. Engl. J. Med. |volume=358 |issue=15 |pages=1547–59 |year=2008 |month=April |pmid=18378520 |doi=10.1056/NEJMoa0801317 |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: A'']]) | <nowiki>"</nowiki>'''1.''' The use of [[ARBs]] in combination with an [[ACE inhibitor]] is not well established in those with systolic [[heart failure]]. <ref name="pmid14610160">{{cite journal |author=Pfeffer MA, McMurray JJ, Velazquez EJ, ''et al.'' |title=Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both |journal=N. Engl. J. Med. |volume=349 |issue=20 |pages=1893–906 |year=2003 |month=November |pmid=14610160 |doi=10.1056/NEJMoa032292 |url=}}</ref><ref name="pmid18378520">{{cite journal |author=Yusuf S, Teo KK, Pogue J, ''et al.'' |title=Telmisartan, ramipril, or both in patients at high risk for vascular events |journal=N. Engl. J. Med. |volume=358 |issue=15 |pages=1547–59 |year=2008 |month=April |pmid=18378520 |doi=10.1056/NEJMoa0801317 |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: A'']]) | ||
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<nowiki>"</nowiki>'''1.''' Use of aldosterone blockade in | <nowiki>"</nowiki>'''1.''' Use of [[aldosterone]] blockade in post–[[myocardial infarction]] patients without significant [[renal dysfunction]]<sup>#</sup> or [[hyperkalemia]]<sup>**</sup> is recommended in patients who are already receiving therapeutic doses of an [[ACE inhibitor]] and [[β-blocker]], who have a [[left ventricular ejection fraction]] ≤40%, and who have either [[diabetes]] or [[heart failure]]. <ref name="pmid12668699">{{cite journal |author=Pitt B, Remme W, Zannad F, ''et al.'' |title=Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction |journal=N. Engl. J. Med. |volume=348 |issue=14 |pages=1309–21 |year=2003 |month=April |pmid=12668699 |doi=10.1056/NEJMoa030207 |url=}}</ref><ref name="pmid21073363">{{cite journal |author=Zannad F, McMurray JJ, Krum H, ''et al.'' |title=Eplerenone in patients with systolic heart failure and mild symptoms |journal=N. Engl. J. Med. |volume=364 |issue=1 |pages=11–21 |year=2011 |month=January |pmid=21073363 |doi=10.1056/NEJMoa1009492 |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: A'']])<nowiki>"</nowiki> | ||
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Revision as of 16:28, 14 November 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Renin-angiotensin-aldosterone System Blockers
2011 AHA/ACCF Guidelines for Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease (DO NOT EDIT) [1]
ACE Inhibitors (DO NOT EDIT) [1]
Class I |
"1. ACE inhibitors should be started and continued indefinitely in all patients with left ventricular ejection fraction]] ≤40% and in those with hypertension, diabetes, or chronic kidney disease, unless contraindicated. [2][3] (Level of Evidence: A)" |
Class IIa |
"1. It is reasonable to use ACE inhibitors in all other patients. [4] (Level of Evidence: B) |
ARBs (DO NOT EDIT) [1]
Class I |
"1. The use of ARBs is recommended in patients who have heart failure or who have had a myocardial infarction with left ventricular ejection fraction ≤40% and who are ACE-inhibitor intolerant. [5][6][7] (Level of Evidence: A)" |
Class IIa |
"1. It is reasonable to use ARBs in other patients who are ACE-inhibitor intolerant. [8] (Level of Evidence: B) |
Class IIb |
"1. The use of ARBs in combination with an ACE inhibitor is not well established in those with systolic heart failure. [7][9] (Level of Evidence: A) |
Aldosterone Blockade (DO NOT EDIT) [1]
Class I |
"1. Use of aldosterone blockade in post–myocardial infarction patients without significant renal dysfunction# or hyperkalemia** is recommended in patients who are already receiving therapeutic doses of an ACE inhibitor and β-blocker, who have a left ventricular ejection fraction ≤40%, and who have either diabetes or heart failure. [10][11] (Level of Evidence: A)" |
“ | # Estimated creatinine clearance should be >30 mL/min. | ” |
“ | ** Potassium should be <5.0 mEq/L. | ” |
Sources
- 2011 AHA/ACCF Guidelines for Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Aterosclerotic Vascular Disease (DO NOT EDIT) [1]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA; et al. (2011). "AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation". Circulation. 124 (22): 2458–73. doi:10.1161/CIR.0b013e318235eb4d. PMID 22052934.
- ↑ Garg R, Yusuf S (1995). "Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials". JAMA. 273 (18): 1450–6. PMID 7654275. Unknown parameter
|month=
ignored (help) - ↑ Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G (2000). "Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators". N. Engl. J. Med. 342 (3): 145–53. doi:10.1056/NEJM200001203420301. PMID 10639539. Unknown parameter
|month=
ignored (help) - ↑ Fox KM (2003). "Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)". Lancet. 362 (9386): 782–8. PMID 13678872. Unknown parameter
|month=
ignored (help) - ↑ Pitt B, Poole-Wilson PA, Segal R; et al. (2000). "Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial--the Losartan Heart Failure Survival Study ELITE II". Lancet. 355 (9215): 1582–7. PMID 10821361. Unknown parameter
|month=
ignored (help) - ↑ Pfeffer MA, Swedberg K, Granger CB; et al. (2003). "Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme". Lancet. 362 (9386): 759–66. PMID 13678868. Unknown parameter
|month=
ignored (help) - ↑ 7.0 7.1 Pfeffer MA, McMurray JJ, Velazquez EJ; et al. (2003). "Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both". N. Engl. J. Med. 349 (20): 1893–906. doi:10.1056/NEJMoa032292. PMID 14610160. Unknown parameter
|month=
ignored (help) - ↑ Yusuf S, Teo K, Anderson C; et al. (2008). "Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial". Lancet. 372 (9644): 1174–83. doi:10.1016/S0140-6736(08)61242-8. PMID 18757085. Unknown parameter
|month=
ignored (help) - ↑ Yusuf S, Teo KK, Pogue J; et al. (2008). "Telmisartan, ramipril, or both in patients at high risk for vascular events". N. Engl. J. Med. 358 (15): 1547–59. doi:10.1056/NEJMoa0801317. PMID 18378520. Unknown parameter
|month=
ignored (help) - ↑ Pitt B, Remme W, Zannad F; et al. (2003). "Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction". N. Engl. J. Med. 348 (14): 1309–21. doi:10.1056/NEJMoa030207. PMID 12668699. Unknown parameter
|month=
ignored (help) - ↑ Zannad F, McMurray JJ, Krum H; et al. (2011). "Eplerenone in patients with systolic heart failure and mild symptoms". N. Engl. J. Med. 364 (1): 11–21. doi:10.1056/NEJMoa1009492. PMID 21073363. Unknown parameter
|month=
ignored (help)