ACE inhibitors reduce mortality and reduce heart failure hospitalization rates in patients with HF-REF, across the spectrum of symptom severity (CONSENSUS, SOLVD).
ACE inhibitors reduce mortality and reduce heart failure hospitalization rates in patients with HF-REF, across the spectrum of symptom severity (CONSENSUS, SOLVD).
ARBs are an alternative in patients unable to tolerate an ACE inibitor because of cough (CHARM-Alternative).
ARBs futher reduce cardiovascular mortality (CHARM-Added) and heart failure hospitalization (CHARM-Added, Val-HeFT) when added to an ACE inhibitor.
Might a direct renin inhibitor (aliskiren) add to the benefit of an ACE inhibitor or be a better alternative to an ACE inhibitor?
Combination therapy
Combination therapy
The addition of aliskiren to an evidence-based dose of enalapril led to more adverse events without an increase in benefit.
This finding differs from the prior ARB “add-on” trials and may reflect a difference in study design (the previous trials did not require an evidence-based dose of background ACE inhibitor).