00:01
The renin-angiotensin agents are very
important in both chronic heart failure
and in acute management of high blood pressure.
00:09
We know that these agents reduce
morbidity and mortality in heart failure.
00:15
They reduce aldosterone
secretion and water retention
and they also reduce total peripheral
resistance or vascular resistance
through its antihypertensive effects.
00:24
I've listed here all of the ACE
inhibitors, and here are all of the ARBs.
00:30
Now the angiotensin receptor blockers have been in
studies shown to be non-inferior to ACE inhibitors.
00:38
You'll generally find on the wards
that cardiologist favor ACE inhibitors
and the ARBs are favored by everyone else.
00:45
I don't think there's really a
right answer in ACE versus ARB.
00:49
The direct renin inhibitors such as
aliskiren, are rarely used in the management
of hypertension and are not currently recommended in the treatment of heart failure.
01:00
Let's move on to the beta blockers.
01:02
Remember that in heart failure we only use
beta blockers once the patient has been stabilized.
01:09
Beta-blockers may actually be harmful in acute heart
failure because it may suppress cardiac function.
01:16
Beta blockers work by two major ways.
01:19
First of all, they reduce heart rate
and increase the stroke volume.
01:23
That's because when you reduce
heart rate, the heart has more time to fill
and as it has more time to fill, each stroke
will become more efficient and powerful.
01:33
It also reduces overall mortality and
progression of chronic heart failure.
01:38
Carvedilol is the favorite
beta blocker in heart failure.
01:42
Major studies have shown
reduction of morbidity and mortality.
01:46
Carvedilol has all alpha, beta, and beta-2 effects,
so it's a very effective agent and
it's very well-tolerated in heart failure.
01:56
Evidence-based medicine has
shown us that when treating heart failure
with reduced ejection fraction, we
should use one of three beta blockers
that have been shown to reduce mortality -
bisoprolol, carvedilol and
sustained release metoprolol.
The lecture Renin-Angiotensin Agents and Beta Blockers – Heart Failure and Angina Management by Pravin Shukle, MD is from the course Cardiovascular Pharmacology. It contains the following chapters:
What is the mechanism of action of carvedilol?
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