Department of Cardiology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
Clin Med (Lond). 2018 Mar;18(2):138-145. doi: 10.7861/clinmedicine.18-2-138.
There are multiple evidence-based drug treatments for chronic heart failure (HF), both disease-modifying agents and those for symptom control. The majority of the evidence base supports drugs used in HF with reduced left ventricular ejection fraction. The mainstay of disease modification involves manipulation of neurohormonal activation that occurs in HF. In addition to established angiotensin-converting enzyme inhibitors, beta blockers and mineralocorticoid receptor antagonists (MRAs), newer agents are now available such as the angiotensin receptor neprilysin inhibitors. Achieving the optimal drug regimen is complex and best performed by a specialist heart failure team. We aim to provide a comprehensive overview of contemporary drug therapies in chronic heart failure, as well as practical guidance for their use. There is a focus on treating patients with challenging comorbidities such as hypotension and chronic kidney disease (CKD), where a thorough understanding of drug therapy is essential. Multiple trials assessing the benefits of new therapies in HF, such as intravenous iron, are also ongoing.
有多种循证药物治疗慢性心力衰竭（HF），包括疾病修饰剂和症状控制药物。大多数证据基础支持用于左心室射血分数降低的心力衰竭的药物。疾病修饰的主要手段涉及对心力衰竭中发生的神经激素激活的操作。除了已确立的血管紧张素转换酶抑制剂、β受体阻滞剂和盐皮质激素受体拮抗剂（MRAs）外，现在还有新的药物，如血管紧张素受体脑啡肽酶抑制剂。实现最佳药物治疗方案很复杂，最好由心力衰竭专家团队来完成。我们旨在提供慢性心力衰竭现代药物治疗的全面概述，以及其使用的实用指导。重点是治疗伴有低血压和慢性肾脏病（CKD）等挑战性合并症的患者，这需要深入了解药物治疗。还有多项评估新疗法（如静脉内铁）在心力衰竭中的益处的试验正在进行中。
