Heart Failure: Viewpoint A Hard Look at Angiotensin Receptor Blockers in Heart Failure

Multiple trials over the past several years have examined indications for angiotensin receptorblockers (ARBs) in the treatment of left ventricular dysfunction, both acutely after myocardialinfarction and in chronic heart failure. Yet despite these data, there is still confusion regardingthe efficacy of ARBs as monotherapy in these patient populations, as well as the specificindications for combination ARB/angiotensin-converting enzyme (ACE) inhibitor therapy.We examine the key differences among the trials—including the ACE inhibitor dose, theARB and its dose, blood pressure reduction, and patient populations—to present ourperspective on ARB use, alone or in combination with ACE inhibitors, in patients withchronic heart failure and post-myocardial infarction left ventricular dysfunction. We concludethat ACE inhibitors remain the first-line therapy for left ventricular dysfunction. Angiotensinreceptor blockers should be reserved for monotherapy in ACE intolerant patients and forcombination therapy in symptomatic class II/III patients with chronic heart failure. (J AmColl Cardiol 2004;44:1841–6) © 2004 by the American College of Cardiology Foundation