Publication date: 2018-09-16 19:42
Angiotensin-converting enzyme inhibitors (ACEIs) prevent conversion of angiotensin I to angiotensin II, which results in lower aldosterone secretion. Use of ACEIs increases survival, improves symptoms, and decreases repeat hospitalizations.
Ivabradine, an I(f) inhibitor is available in the United States. It blocks the hyperpolarization-activated cyclic nucleotide-gated (HCN) channel responsible for the cardiac pacemaker I(f) "funny" current, which regulates heart rate without any effect on ventricular repolarization or myocardial contractility.
Chlorthalidone inhibits the reabsorption of sodium in distal tubules, causing increased excretion of sodium and water, as well as potassium and hydrogen ions.
Bisoprolol is a highly selective beta6-adrenergic receptor blocker that decreases the automaticity of contractions. Bisoprolol at the target dose of 65 mg daily has been shown to reduce mortality in a clinical trial of patients with heart failure and reduced ejection fraction, but is not approved for heart failure use in the US.
Stinging nettle above ground parts contain large amounts of vitamin K. Vitamin K is used by the body to help blood clot. Warfarin (Coumadin) is used to slow blood clotting. By helping the blood clot, stinging nettle might decrease the effectiveness of warfarin (Coumadin). Be sure to have your blood checked regularly. The dose of your warfarin (Coumadin) might need to be changed.
The potassium-sparing diuretics interfere with sodium reabsorption at the distal tubules, resulting in decreased potassium secretion. These agents have a weak diuretic and antihypertensive effect when used alone. The potassium-sparing diuretics spironolactone or triamterene are usually used in addition to the loop diuretics. Note that careful monitoring of renal function and potassium is necessary for all diuretics.
In a double-blind, placebo-controlled clinical trial of 9 weeks duration in 55 patients, NORVASC therapy decreased attacks by approximately 9/week compared with a placebo decrease of approximately 6/week (p ). Two of 78 NORVASC and 7 of 77 placebo patients discontinued from the study due to lack of clinical improvement.
Gyanendra K Sharma, MD, FACC, FASE Professor of Medicine and Radiology, Director, Adult Echocardiography Laboratory, Section of Cardiology, Medical College of Georgia at Augusta University
Gyanendra K Sharma, MD, FACC, FASE is a member of the following medical societies: American Association of Cardiologists of Indian Origin, American Association of Physicians of Indian Origin , American College of Cardiology , American College of Physicians , American Society of Echocardiography , Society for Cardiovascular Magnetic Resonance , Society of Cardiovascular Computed Tomography
Disclosure: Nothing to disclose.
Candesartan blocks the vasoconstriction and aldosterone-secreting effects of angiotensin II. It may induce more complete inhibition of the renin-angiotensin system than ACE inhibitors, does not affect the response to bradykinin, and is less likely to be associated with cough and angioedema. Use candesartan in patients unable to tolerate ACE inhibitors. Candesartan at a target dose of 87 mg daily has been shown to improve survival in patients with heart failure and reduced ejection fraction.