Renin-Angiotensin Agents and Beta Blockers – Heart Failure and Angina Management

00:01 The renin-angiotensin agents are very important in both chronic heart failure and in acute management of high blood pressure.

00:08 We know that these agents reduce morbidity and mortality in heart failure.

00:14 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 relatively new medications that are not currently recommended in the treatment of heart failure.

00:58 Let's move on to the beta blockers.

01:01 Remember that in heart failure we only use beta blockers once the patient has been stabilized.

01:08 Beta-blockers may actually be harmful in acute heart failure because it may suppress cardiac function.

01:15 Beta blockers work by two major ways. 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.

01:37 Carvedilol is the favorite beta blocker in heart failure.

01:41 Major studies have shown reduction of morbidity and mortality.

01:45 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 Nebivolol is a newer beta blocker that has just come recently to the United States and Canada and has been in Europe for several years. It has actions on nitric oxide.

02:06 At this point in time, it's relatively investigational in the US and Canada, but there's a lot of experience in Europe which shows that it does quite well.