Demographics, Treatment Regimens and the Use of Angiotensin-Receptor Blockers in Heart Failure: Findings from the Valsartan Heart Failure Trial

摘要

Heart failure is the only major cardiovascular disease with an incidence and prevalence that continue to increase in the developed world. Early identification and correct treatment of the condition are of paramount importance. In recent years, there has been growing interest in identifying the differences between patients in terms of their risk of heart failure and response to treatment. Differences between men and women, different age groups, patients with varying aetiologies or co-morbidities and differences between ethnic groups are only some of the factors that have been identified. This review surveys the available data on differences in responses to treatment, and discusses the use of angiotensin-receptor blockers in heart failure in light of the recent Valsartan Heart Failure Trial (Val-HeFT). Conclusion: Heart failure is a complex syndrome, a fact that is reflected in the wide spectrum of patient characteristics and breadth of treatments available to physicians. Recommendations will keep evolving as we learn more about the changing aetiology and manifestations of the disease, and as new data become available on old and emerging treatments. The recent addition of ARBs (or at least valsartan) to the list of drugs of benefit in HF is a welcome development. Perhaps the most important message from Val-HeFT is that valsartan significantly reduced the risk of a first morbid event, irrespective of most underlying physiological and demographic parameters. This implies that valsartan will be beneficial in most patients, whether they are old or young, male or female and whatever the aetiology of their HF. As polypharmacy will continue to be the therapy of choice in HF and as no wonder-drug seems to be on the horizon to make the concept obsolete, further blocking the RAS by adding a well-tolerated agent would seem a very welcome expansion of our current treatment options.