ABSTRACT
El tratamiento de la insuficiencia cardíaca (IC) ha cambiado considerablementeen los últimos años, a pesar de que pocos fármacosnuevos han sido aprobados. El tratamiento actual no sólo va dirigidoa mejorar los síntomas, sino también a prevenir el paso de disfunciónsistólica a IC sintomática, a prevenir el remodelado cardíaco, ladisfunción renal y a reducir la mortalidad.Los grupos de fármacos utilizados actualmente son: digitálicos, diuréticos,inhibidores de la enzima conversora de la angiotensina (IECA),betabloqueantes (BB), inhibidores de los receptores de la angiotensinaII (ARA-II) y antagonistas de los receptores de la aldosterona. Lacombinación de dinitrato de isosorbide + hidralazina apenas se usapor sus efectos secundarios y no existe ningún nuevo inotrópico positivoaprobado en IC crónica, ya que todos han demostrado aumentarla mortalidad. El levosimendán es un inotrópico positivo que seutiliza por vía intravenosa en la IC aguda, con un efecto favorablesobre el pronóstico en comparación con placebo y con dobutamina(que lo empeora).Los fármacos aprobados por vía oral se pueden administrar a la vezsi el paciente los tolera, ya que su efecto beneficioso es aditivo. Lamortalidad en dos años de los pacientes en IC leve-moderada secalcula en un 34% con la combinación de digital + diuréticos. Alañadir IECA baja al 22%; al añadir un BB baja al 14%; al añadir unantagonista de la aldosterona baja al 10%. Los ARA-II pueden darseen vez de IECA o añadirse a todos los demás
Treatment of heart failure (HF) has changed in recent years, despitethe paucity of new approved drugs. Current treatment is directed notonly towards improving symptoms, but also to preventing the developmentfrom asymptomatic systolic dysfunction to symptomatic heartfailure, to preventing cardiac remodelling, renal dysfunction and toreducing mortality.The main families of drugs currently used are: cardiac glycosides,diuretics, angiotensin-converting enzyme inhibitors (ACEI), beta-blockingdrugs (BB), angiotensin-II receptor blockers (ARB) and aldosteronereceptor antagonists. The combination isosorbide dinitrate +hydralazine is hardly used due to its side effects and none of the newpositive inotropic drugs has been approved in chronic HF, because allof them increase mortality. Levosimendan is a new positive inotropicagent approved for acute HF by an intravenous route, with a favourableeffect on prognosis vs placebo and vs dobutamine (which worsensthe prognosis). The approved oral drugs can be given at the sametime if the patient tolerates them, because their beneficial effect isadditive. Mortality in two years in mild to moderate HF is 34% withglycosides + diuretics. It falls to 22% when an ACEI is added, to 14%when a BB is added and to 10% when an aldosterone antagonist isadded. ARB can be given instead of an ACEI or be added to the otherdrugs
Subject(s)
Humans , Cardiovascular Agents/therapeutic use , Heart Failure/drug therapy , Clinical Trials as Topic , Drug Therapy, Combination , Guidelines as TopicABSTRACT
Treatment of heart failure (HF) has changed in recent years, despite the paucity of new approved drugs. Current treatment is directed not only towards improving symptoms, but also to preventing the development from asymptomatic systolic dysfunction to symptomatic heart failure, to preventing cardiac remodelling, renal dysfunction and to reducing mortality. The main families of drugs currently used are: cardiac glycosides, diuretics, angiotensin-converting enzyme inhibitors (ACEI), beta-blocking drugs (BB), angiotensin-II receptor blockers (ARB) and aldosterone receptor antagonists. The combination isosorbide dinitrate + hydralazine is hardly used due to its side effects and none of the new positive inotropic drugs has been approved in chronic HF, because all of them increase mortality. Levosimendan is a new positive inotropic agent approved for acute HF by an intravenous route, with a favourable effect on prognosis vs placebo and vs dobutamine (which worsens the prognosis). The approved oral drugs can be given at the same time if the patient tolerates them, because their beneficial effect is additive. Mortality in two years in mild to moderate HF is 34% with glycosides + diuretics. It falls to 22% when an ACEI is added, to 14% when a BB is added and to 10% when an aldosterone antagonist is added. ARB can be given instead of an ACEI or be added to the other drugs.
