ABC of heart failure: Management: diuretics, ACE inhibitors, and nitrates
M K Davies, C R Gibbs, G Y H Lip
- By: C R Gibbs, M K Davies, G Y H Lip
In the past 15 years several large scale, randomised controlled trials have revolutionised the management of patients with chronic heart failure. Although it is clear that some drugs improve symptoms, others offer both symptomatic and prognostic benefits, and the management of heart failure should be aimed at improving both quality of life and survival.
Diuretics and angiotensin converting enzyme (ACE) inhibitors, when combined with non-pharmacological measures, remain the basis of treatment in patients with congestive heart failure. Digoxin has a possible role in some of these patients, however, and the potential benefits of β blockers and spironolactone (an aldosterone antagonist) in chronic heart failure are now increasingly recognised.
Diuretics are effective in providing symptomatic relief and remain the first line treatment, particularly in the presence of oedema. Nevertheless, there is no direct evidence that loop and thiazide diuretics confer prognostic benefit in patients with congestive heart failure.
ACE inhibitors have