Advances in Clinical and Experimental Medicine

Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2006, vol. 15, nr 3, May-June, p. 535–541

Publication type: review article

Language: Polish

Creative Commons BY-NC-ND 3.0 Open Access

Farmakologiczne leczenie przewlekłej niewydolności serca w świetle współczesnych badań klinicznych

Pharmacotherapy for Chronic Heart Failure with a Focus on Recent Clinical Trials

Bogumił Halawa1,

1 Katedra i Klinika Kardiologii AM we Wrocławiu

Streszczenie

Przewlekłą niewydolność serca (p.n.s.) stwierdza się u 1–5% ogólnej populacji, a częstość jej występowania zwiększa się u starszych osób i jest przyczyną zwiększonej ich śmiertelności i umieralności. W artykule przedstawiono zasady farmakologicznego leczenia p.n.s. w świetle współczesnych badań klinicznych. Większość chorych na p.n.s. powinna być leczona w monoterapii lub politerapii diuretykami pętlowymi, inhibitorami enzymu konwertującego (inhibitory ACE), β−blokerami lub lekami blokującymi receptory wiążące angiotensynę II, jeśli nie ma przeciwwskazań do ich podawania. Diuretyki są lekami podstawowymi u chorych z zatrzymaniem w organizmie wody i należy je stosować z inhibitorem ACE, ale za leki pierwszego wyboru, zarówno w zapobieganiu, jak i leczeniu p.n.s. uznaje się inhibitory ACE i leki blokujące inhibitory β. Leki blokujące receptory wiążące angiotensynę ze względu na zmniejszanie przez nie umieralności są zalecane u tych chorych na p.n.s., którzy nie tolerują inhibitorów ACE. Spironolakton stosuje się jest u chorych z III i IV klasą czynnościowej niewydolności krążenia według NYHA, u których nie uzyskano poprawy po stosowaniu diuretyków, inhibitora ACE, leku blokującego receptory β i digoksyny. Mimo postępów w wiedzy medycznej, nadal wysoka umieralność chorych na p.n.s. nakazuje poszukiwanie nowych leków stosowanych w zapobieganiu i leczeniu tej choroby, a za takie można obecnie uznać inhibitory wazopeptydazy i blokery aldosteronu.

Abstract

Chronic heart failure affects (CHF) between 1–5% of the population, rise steeply with age, and is an important cause of morbidity and mortality. This article reviews the evidence on the pharmacologic treatment of heart failure with focus on recent clinical trials. Most patients with CHF should be managed with monotherapy or combination of a loop diuretics, an angiotensin converting enzyme inhibitors (ACE inhibitor), β−blocker or angiotensin receptor blockers, unless there are contraindication. Diuretics are essential for symptomatic treatment when fluid overload is present, and should be administrated in combination with ACE inhibitors, but strong evidence supports the use of ACE inhibitors and β−blockers as first−line therapies to prevent and treat heart failure. Angiotensin–receptor blockers are prescribed to reduce death from cardiovascular cause in patients who cannot tolerance ACE inhibitors. Spironolactone is recommended in patients who have NYHA class III to IV symptoms despite therapies with diuretics, ACE inhibitors, β−blockers, angiotensin receptor blockers or digoxin. Despite recent achievements of the treatment of heart failure mortality remains high, therefore the drug development challenge for the future to identify new drug and therapies. Important new drugs for the treatment of heart failure include vasopeptidase inhibitor and aldosterone blocker.

Słowa kluczowe

przewlekła niewydolność serca, współczesne badania kliniczne, leczenie

Key words

chronic heart failure, recent clinical trails, management

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