Abstract
The renin-angiotensin-aldosteron-system (RAAS) appears to play a key role not only in the pathophysiology of systolic but also of „diastolic” heart failure. In the prospective, randomized, double-blind I-PRESERVE study irbesartan (target dose 300 mg/day) did not improve mortality and morbidity in patients (n = 4128) with heart failure and preserved left ventricular ejection fraction (LVEF). In contrast to systolic heart failure, patients with „diastolic” heart failure obviously do not benefit prognostically from treatment with a sartan. Besides early and intense blood pressure control therapy of „diastolic” heart failure remains to be based on empiric approaches including (I) reduction of cardiac filling pressures with diuretics, (II) improvement of ventricular filling by rate control with beta-blockers, (III) reduction of leftventricular hypertrophy by ACE inhibitors or sartans, and (IV) reduction of myocardial stiffness (e. g. fibrosis) with aldosterone antagonists.
Literatur
-
1
Redfield M M, Jacobsen S J, Burnett J C. et al .
Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic.
JAMA.
2003;
289
194-202
-
2
Pieske B.
Diastolische Herzinsuffizienz.
Kardiologie up2date.
2006;
2
27-45
-
3
Hoppe U C, Böhm M, Dietz R. et al .
Leitlinien zur Therapie der chronischen Herzinsuffizienz.
Z Kardiol.
2005;
94
488-509
-
4
Yusuf S, Pfeffer M A, Swedberg K. et al .
Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial.
Lancet.
2003;
362
777-781
-
5
Cleland J G, Tendera M, Adamus J. et al .
The perindopril in elderly people with chronic heart failure (PEP-CHF) study.
Eur Heart J.
2006;
27
2338-2345
-
6
Massie B M, Carson P E, McMurray J J. et al .
Irbsesartan in patients with heart failure and preserved ejection fraction.
N Engl J Med.
2008;
359
2456-2467
-
7
Anand I S, Fisher L D, Chiang Y T. et al .
Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (ValHeFT).
Circulation.
2003;
107
1278-1283
-
8
Lubien E, deMaria A, Krishnaswamy P. et al .
Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings.
Circulation.
2002;
105
595-601
-
9
Yusuf S, Diener H C, Sacco R L. et al .
Telmisartan to prevent recurrent stroke and cardiovascular events.
N Engl J Med.
2008;
359
1225-1237
-
10
Berl T, Hunsicker L G, Lewis J B. et al .
Cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial of patients with type 2 diabetes and overt nephropathy.
Ann Intern Med.
2003;
138
542-549
Prof. Dr. med. Markus Haass
Innere Medizin I (Kardiologie, Angiologie und Internistische Intensivmedizin)
Theresienkrankenhaus
Bassermannstr. 1
68165 Mannheim
eMail: m.haass@theresienkrankenhaus.de
