Marcus D Flather, Salim Yusuf, Lars Kober, Marc Pfeffer, et al , for the ACE-Inhibitor Myocardial Infarction Collaborative Group. (Hamilton Health Sciences Corporation Research Centre).
Long-term ACE-Inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients.
The Lancet 2000; 6 May; 355: 1575-81.
Interpretation: This systematic overview shows that ACE inhibitor lower rates of mortality, myocardial infarction, and hospital admission for heart failure in patients with left-ventricular dysfunction or heart failure with or without a recent myocardial infarct. The use of ACE inhibitors should be part of routine practice in these patients.
Bertram Pitt, Philip A Poole-Wilson, Robert Segal, et al (Divison of Cardiology, University of Michigan School of Medicien, USA)
Effect of Losartan compared with Captopril on mortality in patients with symptomatic heart failure: randomised trial – the Losartan Heart Failure Survival Study ELITE II
The Lancet 2000; 6 May; 355: 1582-87
Interpretation: Losartan was not superior to captopril in improving survival in elderly heart-failure patients, but was significantly better tolerated.
Iain B Squire & David B. Barnett (Department of Medicine and Therapeutics, University of Leicester, UK)
The rational use of b-adrenoceptor blockers in the treatment of heart failure. The changing face of an old therapy.
Br.J.Clin Pharmacol, 49, 1-9.
Summary : The concept of using beta-blockers in the treatment of heart failure was introduced in the 1970s. There is a common belief that beta-blockade is contraindicated in treatment of patients with stable chronic heart failure.
Beta-blockade would be inappropriate in acute or decompensated heart failure. However, chronic adrenergic stimulation leads to desensitization of beta receptor signaling pathway- such changes are seen in failing heart.
Recent studies have used a regimen of initiation beta-blockade at a low-dose with subsequent dose-titration. The doses used in these trials are 200mg once daily metoprolol and 50mg twice daily for carvedilol and 10mg once daily bisoprolol. There is no data to suggest superiority of any one beta blocker.
The case for a beneficial effect of beta-blockade in patients with stable, chronic heart failure is established. Available data pertains to mild to moderate heart failure. Studies have shown benefit in terms of morbidity and mortality.
Aidan P Bolger and Stefan D Anker (England, Germany)
Tumour Necrosis Factor in Chronic Heart Failure.
Drugs, Dec.2000,60(6): 1245-1257
Higher levels of the pro-inflammatory cytokine tumor necrosis factor (TNF) are found in the circulation and in the myocardium of patients with CHF than in controls.
Several established pharmacological therapies for patients with CHF, including angiotensin converting enzyme inhibitors, B-blockers, and phosphodiestrase inhibitors may modify cellular TNF production by their action on intracellular mechanisms.