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.
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 mechanism of action best describes how carvedilol works?
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