Journal of cardiac failure
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Review Meta Analysis Comparative Study
Safety and tolerability of angiotensin-converting enzyme inhibitor versus the combination of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker in patients with left ventricular dysfunction: a systematic review and meta-analysis of randomized controlled trials.
The addition of an angiotensin receptor blocker (ARB) to an angiotensin-converting enzyme inhibitor (ACEI) in patients with heart failure remains controversial. A recent meta-analysis showed that the combination therapy reduces hospitalization without improved survival. Whether excess risk is associated with this strategy has not been fully explored. We sought to quantify the risk of adverse events of combination therapy (ACEI+ARB) versus ACEI alone. ⋯ The current cumulative evidence suggests that patients with left ventricular dysfunction have an increased risk of adverse events leading to discontinuation on ACEI+ARB combination therapy compared with ACEI alone. This excess risk, coupled with a lack of consistent mortality benefit, suggests that ARBs should not routinely be added to ACEI therapy for left ventricular dysfunction. If chosen, the combination strategy may warrant closer patient monitoring to detect adverse effects.
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Randomized Controlled Trial
Effects of 5'-phosphodiesterase four-week long inhibition with sildenafil in patients with chronic heart failure: a double-blind, placebo-controlled clinical trial.
The effects of chronic inhibition of 5'-phosphodiesterase with sildenafil on functional capacity, ventilatory efficiency, oxygen uptake, pulmonary hypertension, and endothelial function in chronic heart failure (CHF) are unknown. ⋯ Sildenafil administration for 4 weeks in stable outpatients with CHF improves functional capacity, ventilatory efficiency, oxygen uptake kinetics, and pulmonary hypertension. These effects may be mediated in part by improvements in endothelial function.
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Studies with natriuretic peptides have suggested that physicians do not treat heart acute failure (AHF) aggressively enough, and predischarge B-type natriuretic peptide (BNP) levels may be a useful reminder that more treatment is required. The purpose of this study was to demonstrate that variations in BNP levels during hormone-guided treatment and measured body hydration status enable the timing of the patient's discharge to be optimized. ⋯ Our study demonstrates the usefulness of BNP in intrahospital stratification of AHF, in the decision-making process, and as a tool for "tailored therapy." Integrating this approach into the routine assessment of HF patients would allow clinicians to more accurately identify high-risk patients, who may derive increased benefit from intensive in-hospital management strategies.