a Cardiology Division, Department of Medicine , Westchester Medical Center and New York Medical College , Valhalla , NY , USA.
Expert Opin Drug Saf. 2019 Jan;18(1):37-49. doi: 10.1080/14740338.2018.1512580. Epub 2018 Aug 31.
Heart failure (HF) is an important public health problem with an increasing prevalence across the globe. The mortality rates from this complex clinical problem have stabilized in the recent years with the use of pharmacotherapeutics which demonstrated survival benefits in patients with HF with reduced ejection fraction (HFrEF).
We reviewed the seven classes of medications which constitute the guideline-directed medical therapy (GDMT) in chronic HF patients. We discussed clinical trials which support or contradict their use, potential adverse events, and available real-world data on utilization and safety.
Loop diuretics form a major component of baseline therapy in HF patients to maintain euvolemia. As diastolic HF is more volume sensitive then systolic HF, diuretic use should be judiciously monitored to prevent states of volume depletion and associated complications. Neurohormonal modulation with pharmacotherapies are efficacious in reducing morbidity and mortality in the chronic HFrEF population. However, registry data showed that treatment intolerance and adverse events result in lower prescription rates of GDMT. Sacubitril/valsartan represents a major therapeutic advance in the treatment of HFrEF patients and can be safely used in addition to other GDMTs. Therapies to improve outcomes in diastolic HF patients are needed.
心力衰竭（HF）是一个重要的公共卫生问题，在全球范围内的患病率不断增加。近年来，由于使用了能够为射血分数降低的心力衰竭（HFrEF）患者带来生存获益的药物治疗，这种复杂临床问题的死亡率已经稳定下来。
我们回顾了构成慢性心力衰竭患者指南指导的药物治疗（GDMT）的七类药物。我们讨论了支持或反驳其使用的临床试验、潜在的不良反应，以及关于使用和安全性的现有真实世界数据。
在心力衰竭患者中，袢利尿剂是基础治疗的主要组成部分，以维持血容量正常。由于舒张性心力衰竭比收缩性心力衰竭对血容量更敏感，因此应谨慎监测利尿剂的使用，以防止出现血容量不足和相关并发症。神经激素调节的药物治疗在降低慢性 HFrEF 人群的发病率和死亡率方面是有效的。然而，注册数据显示，治疗不耐受和不良反应导致 GDMT 的处方率降低。沙库巴曲缬沙坦在治疗 HFrEF 患者方面代表了一个重大的治疗进展，可以与其他 GDMT 联合安全使用。需要有治疗舒张性心力衰竭患者的新方法。
