ACEi and ARBS in Hypertension and Heart Failure (Current Cardiovascular Therapy Book 5)

The renin angiotensin system is implicated in the progression of atherosclerotic disease as well as of left ventricular dysfunction. Angiotensin converting enzyme inhibitors and AT1 receptor antagonists have been proven to reduce morbidity and mortality in patients with left ventricular dysfunction or in those at high cardiovascular risk with preserved ventricular function. This book is intended to summarize evidences and provide a rationale for the appropriate use of RAS antagonists in cardiovascular diseases. It will be presented as highly practical information on this topic, written in a quick-access, no-nonsense format. The emphasis will be on a just-the-facts clinical approach, heavy on tabular material, light on dense prose. The involvement of the ISCP will ensure that the best quality contributors will be involved and establish a consistent approach to each topic in the series and this title is no exception. It will contain practical illustrations and is designed to improve understand and practical usage of cardiovascular drugs in specific clinical areas. Preface 6 Contents 8 Contributors 10 Chapter 1: Angiotensin Converting Enzyme Inhibitors and AT1 Antagonists for Treatment of Hypertension 12 RAS Inhibition and Blood Pressure Lowering 15 RAS Inhibition and Hypertension-Related Metabolic Abnormalities 16 Dyslipidemias 16 Metabolic Syndrome and Obesity 18 Insulin Resistance and Diabetes 20 RAS Inhibition and Hypertension-Related TOD 26 Left Ventricular Hypertrophy 27 Chronic Kidney Disease 30 Dual RAS Inhibition 32 Atherosclerosis 33 RAS Inhibition and CV Events 35 Stroke 35 Myocardial Infarction 37 RAS Inhibitors and Mortality 40 References 41 Chapter 2: ACE Inhibitor and Renin–Angiotensin System the Cornerstone of Therapy for Systolic Heart Failure 51 Definition of Heart Failure 51 Epidemiology, Incidence, Prevalence and Natural History of Heart Failure 53 Aetiology of Heart Failure 55 Pathophysiology of Heart Failure 58 The Renin-Angiotensin System 61 Focus on Blockade of the Renin–Angiotensin System 63 Trials That Support the Use of Angiotensing-­Converting Enzyme Inhibitors 65 ACE-Inhibitors Compared with Angiotensin Receptor Blockers 71 Use of the ACE Inhibitors in the Hearth Failure: ESC and ACCF/AHA Guidelines 72 References 77 Chapter 3: Impact of Chronic Kidney Disease and Diabetes Mellitus on Choice of Renin Angiotensin System-­Inhibitors in Patients with Hypertension and Heart Failure 83 Introduction 83 Choice of RAAS Inhibitors in Patients with Chronic Kidney Disease 85 Studies in Diabetic or Non-diabetic Proteinuric Kidney Disease 85 Studies in Non-proteinuric Kidney Disease 90 High Doses of RAAS-Inhibitors or Dual RAAS Blockade 94 Choice of Antihypertensive Treatment in Patients with Diabetes Mellitus 105 Effects of Antihypertensive Agents on Insulin Sensitivity 105 Effects of Antihypertensive Agents on New-Onset DM 107 Data from Hypertension Outcome Trials Evaluating New-Onset DM as a Secondary Outcome 107 Data from Trials and Meta-analyses Investigating the Effects of Antihypertensive Agents on Metabolic Parameters and New-Onset DM 112 New-Onset DM and Cardiovascular Risk 114 Conclusion 116 References 117 Chapter 4: Target Organ Damage and RAAS Blockade 129 Introduction 129 RAAS Dysregulation and Target Organ Damage 131 Monotherapy with ACEIs 133 Monotherapy with ARBs 138 Dual Therapy 144 Comparison Between ACEIs and ARBs 151 Conclusions 152 References 153 Index 159 This book summarizes how the renin angiotensin system is implicated in the progression of atherosclerotic disease as well as of left ventricular dysfunction and reviews the action of angiotensin converting enzyme inhibitors and AT1 receptor antagonists on reducing morbidity and mortality in patients with left ventricular dysfunction or in those at high cardiovascular risk with preserved ventricular function. ACEi and ARBS in Hypertension and Heart Failure is a highly practical reference reviewing the evidence and providing a rationale for the appropriate use of RAS antagonists in cardiovascular diseases. It is written in an easy-to-follow format and with many illustrations to aid clarity and the assimilation of information. Each chapter is written by established authorities in their fields who are also experienced in explaining often complex concepts. The result is a unique book which is not only comprehensive but also clear and useful for the busy medical practitioner Front Matter....Pages i-x Angiotensin Converting Enzyme Inhibitors and AT1 Antagonists for Treatment of Hypertension....Pages 1-39 ACE Inhibitor and Renin–Angiotensin System the Cornerstone of Therapy for Systolic Heart Failure....Pages 41-72 Impact of Chronic Kidney Disease and Diabetes Mellitus on Choice of Renin Angiotensin System-Inhibitors in Patients with Hypertension and Heart Failure....Pages 73-118 Target Organ Damage and RAAS Blockade....Pages 119-148 Back Matter....Pages 149-150