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Importance of endogenous compensatory vasoactive peptides in broadening the effects of inhibitors of the renin-angiotensin system for the treatment of heart failure.

Abstract The magnitude of the clinical benefits produced by inhibitors of the renin-angiotensin system in heart failure has been modest, possibly because of the ability of renin-angiotensin activity to escape from suppression during long-term treatment. Efforts to intensify pharmacological blockade by use of dual inhibitors that interfere with the renin-angiotensin system at multiple sites have not yielded consistent incremental clinical benefits, but have been associated with serious adverse reactions. By contrast, potentiation of endogenous compensatory vasoactive peptides can act to enhance the survival effects of inhibitors of the renin-angiotensin system, as evidenced by trials that have compared angiotensin-converting enzyme inhibitors with drugs that inhibit both the renin-angiotensin system and neprilysin. Several endogenous vasoactive peptides act as adaptive mechanisms, and their augmentation could help to broaden the benefits of renin-angiotensin system inhibitors for patients with heart failure.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title lancet (london, england)
Publication Year Start




PMID- 27919443
OWN - NLM
STAT- Publisher
DA  - 20161206
LR  - 20161207
IS  - 1474-547X (Electronic)
IS  - 0140-6736 (Linking)
DP  - 2016 Dec 02
TI  - Importance of endogenous compensatory vasoactive peptides in broadening the
      effects of inhibitors of the renin-angiotensin system for the treatment of heart 
      failure.
LID - S0140-6736(16)30969-2 [pii]
LID - 10.1016/S0140-6736(16)30969-2 [doi]
AB  - The magnitude of the clinical benefits produced by inhibitors of the
      renin-angiotensin system in heart failure has been modest, possibly because of
      the ability of renin-angiotensin activity to escape from suppression during
      long-term treatment. Efforts to intensify pharmacological blockade by use of dual
      inhibitors that interfere with the renin-angiotensin system at multiple sites
      have not yielded consistent incremental clinical benefits, but have been
      associated with serious adverse reactions. By contrast, potentiation of
      endogenous compensatory vasoactive peptides can act to enhance the survival
      effects of inhibitors of the renin-angiotensin system, as evidenced by trials
      that have compared angiotensin-converting enzyme inhibitors with drugs that
      inhibit both the renin-angiotensin system and neprilysin. Several endogenous
      vasoactive peptides act as adaptive mechanisms, and their augmentation could help
      to broaden the benefits of renin-angiotensin system inhibitors for patients with 
      heart failure.
CI  - Copyright A(c) 2016 Elsevier Ltd. All rights reserved.
FAU - Packer, Milton
AU  - Packer M
AD  - Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas,
      TX, USA. Electronic address: [email protected]
FAU - McMurray, John J V
AU  - McMurray JJ
AD  - British Heart Foundation Cardiovascular Research Center, University of Glasgow,
      Glasgow, UK.
LA  - eng
PT  - Review
PT  - Journal Article
DEP - 20161202
PL  - England
TA  - Lancet
JT  - Lancet (London, England)
JID - 2985213R
EDAT- 2016/12/07 06:00
MHDA- 2016/12/07 06:00
CRDT- 2016/12/07 06:00
AID - S0140-6736(16)30969-2 [pii]
AID - 10.1016/S0140-6736(16)30969-2 [doi]
PST - aheadofprint
SO  - Lancet. 2016 Dec 2. pii: S0140-6736(16)30969-2. doi:
      10.1016/S0140-6736(16)30969-2.

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