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(Circulation. 1999;100:1032-1034.)
© 1999 American Heart Association, Inc.

Editorial

Role of Angiotensin Receptor Blockers in Heart Failure

Not Yet RESOLVD

Barry H. Greenberg, MD

From the University of California, San Diego.

Correspondence to Barry H. Greenberg, MD, Professor of Medicine, Director, Heart Failure/Cardiac Transplantation Program, UCSD Medical Center, 200 W Arbor Dr, San Diego, CA 92103-8411. E-mail bgreenberg@ucsd.edu

Key Words: Editorials • heart failure • cardiac volume • natriuretic peptides

	Introduction

 
There is convincing evidence that the renin-angiotensin aldosterone system (RAAS) plays a major role in the pathogenesis and progression of heart failure. Angiotensin (Ang) II is a potent vasoconstrictor agent, and through the release of aldosterone, it promotes salt and water retention. Moreover, Ang II is a growth factor for both cardiac myocytes and fibroblasts.^{1 2} Exposure of these cells to Ang II leads to the induction of genes that produce characteristic phenotypic alterations that are similar to those seen during cardiac remodeling.³ Ang II also contributes to the generalized (and mostly deleterious) activation of other neurohormonal systems both within the heart and throughout the body by promoting release of agents such as norepinephrine and endothelin. The immediate effects of RAAS activation are increased cardiac afterload and preload. The long-term effects appear to include adverse cardiac remodeling characterized by ventricular dilatation, hypertrophy, and changes in chamber configuration, all of which predispose to progressive left ventricular (LV) dysfunction.⁴ Perhaps the strongest evidence for the role of the RAAS in heart failure, however, comes from studies in experimental animal models and in human patients demonstrating that interruption of this system will have favorable effects on the clinical course, including prolonged survival.^{5 6 7}

ACE inhibitors (ACEIs) have been a cornerstone of therapy for patients with LV dysfunction for nearly 2 decades. The benefits of ACEIs have been demonstrated in myocardial infarction (MI) survivors⁸ and in patients with LV dysfunction ranging from those who are asymptomatic to those with New York Heart Association functional class IV . . . [Full Text of this Article]

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