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

by Pravin Shukle, MD
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    The renin-angiotensin agents are very important in both chronic heart failure and in acute management of high blood pressure. We know that these agents reduce morbidity and mortality in heart failure. They reduce aldosterone secretion and water retention, and they also reduce total peripheral resistance or vascular resistance through its antihypertensive effects. I've listed here all of the ACE inhibitors. And here are all of the ARBs. Now, the angiotensin receptor blockers have been in studies shown to be "non-inferior" to ACE inhibitors. You'll generally find on the wards that cardiologists favor ACE inhibitors, and the ARBs are favored by everyone else. I don't think there is really a right answer in ACEi versus ARB. The direct renin inhibitors are a relatively new class that I discussed in my hypertension lecture, we don't have a lot of great information on heart failure at this time. Now, it's still maybe useful and beneficial in heart failure. But at this point in time, in 2016, it's not routinely used. Let's move on to the beta blockers. Remember that in heart failure, we only use beta blockers once the patient has been stabilized. Beta blockers may actually be harmful in acute heart failure because it may suppress cardiac function. Beta blockers work by two major ways. First of all, they reduce heart rate and increases stroke volume. 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. It also reduces overall mortality and progression of chronic heart failure. Carvedilol is the favourite beta blocker in heart failure. Major studies have shown reduction of morbidity and mortality. Carvedilol has all alpha, beta, and beta 2 effects, so it's a very effective agent, and it's...

    About the Lecture

    The lecture Renin-Angiotensin Agents and Beta Blockers – Angina and Heart Failure Management by Pravin Shukle, MD is from the course Cardiovascular Pharmacology. It contains the following chapters:

    • Renin-angiotensin Agents
    • β1-Blockers

    Included Quiz Questions

    1. Has alpha-1, beta-1, and beta-2 effects.
    2. Should not be used in chronic heart failure.
    3. Can be used in acute decompensated heart failure.
    4. decreases stroke volume.

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

     Pravin Shukle, MD

    Pravin Shukle, MD


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