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.

00:09 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.

00:50 The direct renin inhibitors such as aliskiren, are relatively new medications that are not currently recommended in the treatment of heart failure.

00:59 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.