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

by Pravin Shukle, MD

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    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.


    About the Lecture

    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:

    • Renin-angiotensin Agents
    • β1-Blockers

    Included Quiz Questions

    1. It is an alpha-1, beta-1, and beta-2 receptor blocker.
    2. It is an alpha-1, beta-1, and beta-2 receptor blocker and a calcium channel blocker.
    3. It is an alpha-1 and beta-1 receptor blocker.
    4. It is a stimulator of alpha-1, beta-1, and beta-2 receptors.
    5. It is a stimulator of beta-1 and beta-2 adrenergic receptors.

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

     Pravin Shukle, MD

    Pravin Shukle, MD


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