Past and future of chronic heart failure therapy

Abstract

The modern concept of the pathogenesis of chronic heart failure accumulates various theories, since it is not necessary to count on the fact that with the help of one seemingly quite logical concept of pathogenesis it is possible to explain all the disorders in a patient suffering from heart failure, and, moreover, to solve all the problems of therapy, affecting the only mechanism of development and progression of circulatory failure.The main steps leading to the development of a new treatment regimen for patients with severe heart failure are summarized. The article covers the history of the discovery of renin- angiotensin-aldosterone and natriuretic systems, as well as the mechanisms of their interaction. The questions of synthesis, secretion, clearance of vasoactive substances regulating these systems are considered. The diagnostic and prognostic significance of drugs aimed at various links of pathogenesis in patients with chronic heart failure was analyzed. Considered both positive and negative results of clinical studies, which in the end led to the creation of a new drug LCZ696, a first-in-class angiotensin receptor-neprilysin inhibitor. The results of the clinical study PARADIGM-HF were evaluated, and the practical and clinical significance of the possibility of using LCZ696 in different categories of patients was determined. The unequivocal superiority of a new class of drugs angiotensin receptor-neprilysin inhibitor between inhibitor enalapril on the results of clinical studies no doubt. LCZ696 can replace conventional angiotensin converting enzyme inhibitors or angiotensin receptor blockers in many patients suffering from chronic heart failure with a reduced ejection fraction.

Keywords

chronic heart failure / renin-angiotensin-aldosterone system / natriuretic peptides / adrenomedullin / neprilysin / valsartan / sacubitril / omapatrilat

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