Die I-PRESERVE-Studie: Sartane und ACE-Hemmer bei diastolischer Herzinsuffizienz

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.

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