Cardiology in review
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Cardiology in review · Nov 2005
ReviewAngiotensin receptor blockers in congestive heart failure: evidence, concerns, and controversies.
Heart failure results in neurohormonal activation of which the renin-angiotensin-aldosterone system (RAS) is the main mediator. Activation of this system leads to the production of angiotensin II (ATII), which leads to multiple adverse short-term and long-term effects, including hemodynamic dysfunction, renal dysfunction, inflammation, and cardiac remodeling. Angiotensin-converting enzyme inhibitors (ACEIs) exert favorable effects in congestive heart failure (CHF) by inhibiting the production of ATII. ⋯ Hence, it was thought that angiotensin receptor blockers (ARBs) might be more useful in CHF because they directly block the ATII receptors. Many studies have been done to evaluate the role of ARBs in CHF. We reviewed these studies and have attempted to define the place and ARBs in the therapy for CHF.
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Cardiology in review · Nov 2005
ReviewPathophysiology and medical management of systemic hypertension in pregnancy.
Hypertension in pregnancy includes a group of distinct disorders that require special consideration in both prevention and pharmacologic treatment. In recent years, there have been few advances regarding the pathophysiology and prevention of preeclampsia or in the recommendations for first-line drug therapy for its hypertensive complications. Similarly, the recommendations for pharmacologic treatment of women with chronic hypertension antedating pregnancy have changed little primarily because first-line medications have the advantage of having had more extensive research experience. Recent clinical trials have demonstrated the efficacy and safety of various second-line drugs for the hypertensive disorders of pregnancy; whether these therapies can eventually replace the standard recommended medications will require more extensive long-term investigation.