Kim M, Kukin M
Zena and Michael A Wiener Cardiovascular Institute, Mount Sinai School of Medicine, One Gustave L Levy Place, New York, NY 10128, USA.
Expert Opin Pharmacother. 2000 Jan;1(2):261-9. doi: 10.1517/14656566.1.2.261.
The management of heart failure has evolved in parallel with advances in the understanding of the disease process. Inotropes and diuretics are used to combat pump failure and fluid overload. While no convincing data has emerged regarding the long-term safety of inotropes, new exciting data concerning the role of diuretics, especially aldactone, has led to a renewed interest in this class of drug therapy. Angiotensin converting enzyme inhibitors (ACE inhibitors) were noted to not only affect symptomatology but also decrease mortality by interfering with the renin-angiotensin-aldosterone system. Recent research has focused on more complete blockade of the renin-angiotensin system than that achieved with ACE inhibitors alone with the addition of direct angiotensin II receptor blockers. This new class of drugs may become not only a reasonable alternative to ACE inhibitors in patients intolerant of the drug but also a possible addition to ACE inhibitors in the battle to prevent progression of remodelling and disease. beta-blockers are the most exciting new class of drugs used to combat heart failure. They appear not only to combat the remodelling process that occurs in the progression of disease but also other pathological events such as apoptosis and cellular oxidation. New medical therapies currently being investigated include novel agents such as endothelin antagonists, natriuretic peptides, vasopressin antagonists and anticytokine agents--all part of a new era in drug management of heart failure that has evolved with continued advances in the understanding of chronic heart failure (CHF).
心力衰竭的管理与对疾病进程认识的进步同步发展。正性肌力药和利尿剂用于对抗泵衰竭和液体超负荷。虽然关于正性肌力药的长期安全性尚未出现令人信服的数据，但有关利尿剂，尤其是螺内酯作用的新的令人兴奋的数据，引发了对这类药物治疗的新兴趣。人们注意到血管紧张素转换酶抑制剂（ACE抑制剂）不仅影响症状，还通过干扰肾素-血管紧张素-醛固酮系统降低死亡率。最近的研究集中在比单独使用ACE抑制剂更完全地阻断肾素-血管紧张素系统，方法是添加直接血管紧张素II受体阻滞剂。这类新药不仅可能成为不耐受ACE抑制剂患者的合理替代药物，而且在预防重塑和疾病进展的斗争中可能成为ACE抑制剂的补充药物。β受体阻滞剂是用于对抗心力衰竭的最令人兴奋的一类新药。它们似乎不仅能对抗疾病进展过程中发生的重塑过程，还能对抗其他病理事件，如细胞凋亡和细胞氧化。目前正在研究的新医学疗法包括新型药物，如内皮素拮抗剂、利钠肽、血管加压素拮抗剂和抗细胞因子药物——所有这些都是随着对慢性心力衰竭（CHF）认识的不断进步而发展起来的心力衰竭药物管理新时代的一部分。
