Sackner-Bernstein Jonathan D, Hart David
Division of Cardiology, St Luke's-Roosevelt Hospital, New York, NY, USA.
Mt Sinai J Med. 2004 Mar;71(2):115-26.
Pharmacologic management of chronic heart failure rests on appropriate volume management followed by neurohormonal antagonism. Despite the rationale for neurohormonal antagonists, their use remains low. Definitive studies establish that neurohormonal antagonists are effective across the spectrum of disease, from the early Stage A patient at risk of developing structural heart disease and symptomatic heart failure to the Stage D patient with symptoms at rest. Although many investigators and clinicians seem focused on the next new scientific breakthrough, published studies delineate strategies that will reduce death and disability for those at risk and those with symptomatic chronic heart failure. In essence, the broad use of neurohormonal antagonists, consistent with the reports of large-scale trials that have been reported, will markedly reduce the risk of disease progression and death. Overall prognosis however remains poor. We review the data from these trials to encourage clinicians to use these proven neurohormonal antagonists in optimizing therapeutic strategy.
慢性心力衰竭的药物治疗基于适当的容量管理，随后进行神经激素拮抗。尽管使用神经激素拮抗剂有其理论依据，但其使用率仍然较低。确切的研究表明，神经激素拮抗剂在整个疾病谱中均有效，从有发生结构性心脏病和症状性心力衰竭风险的早期A期患者到静息时有症状的D期患者。尽管许多研究者和临床医生似乎专注于下一个新的科学突破，但已发表的研究描述了可降低有风险者和有症状慢性心力衰竭患者死亡和残疾的策略。从本质上讲，与已报道的大规模试验结果一致，广泛使用神经激素拮抗剂将显著降低疾病进展和死亡风险。然而总体预后仍然很差。我们回顾这些试验的数据，以鼓励临床医生在优化治疗策略时使用这些经证实有效的神经激素拮抗剂。
