McKelvie R S
Ontario Ministry of Health, Hamilton, Ont.
Can Fam Physician. 1998 Dec;44:2689-92, 2695-8.
To review therapies for treating patients with heart failure (HF).
Recommendations in this paper are mainly based on the results of randomized controlled trials. To a lesser extent, data from smaller, more physiologic studies are included. Where appropriate, recommendations are based on the results of a consensus conference.
Although pharmacologic therapy is the main strategy for treating HF patients, general measures, such as counseling and advice about regular physical activity, are an important component of management. Use of angiotensin-converting enzyme inhibitors (ACE-I) is central to treating HF patients, because these agents decrease mortality and morbidity significantly. Digoxin does not reduce mortality but does reduce morbidity. Angiotensin II antagonists, although found to provide clinical benefit equal to ACE-I, have not been found as yet to have similar effects on mortality and morbidity. Diuretics and nitrates are useful for treating these patients' symptoms. Calcium channel blockers should generally be avoided.
Angiotensin-converting enzyme inhibitors are the therapy of choice for HF patients and should be used in all cases unless there are contraindications or clear evidence of intolerance. All other therapies are used mainly for symptom relief.
综述治疗心力衰竭（HF）患者的疗法。
本文中的推荐主要基于随机对照试验的结果。在较小程度上，纳入了来自规模较小、更具生理学意义研究的数据。在适当情况下，推荐基于共识会议的结果。
尽管药物治疗是治疗HF患者的主要策略，但一般措施，如关于规律体育活动的咨询和建议，是管理的重要组成部分。使用血管紧张素转换酶抑制剂（ACE-I）是治疗HF患者的核心，因为这些药物可显著降低死亡率和发病率。地高辛虽不降低死亡率，但可降低发病率。血管紧张素II拮抗剂虽被发现具有与ACE-I相当的临床益处，但尚未发现其对死亡率和发病率有类似影响。利尿剂和硝酸盐对治疗这些患者的症状有用。一般应避免使用钙通道阻滞剂。
血管紧张素转换酶抑制剂是HF患者的首选治疗方法，除非有禁忌证或明确的不耐受证据，否则应在所有病例中使用。所有其他疗法主要用于缓解症状。
