Combined renin-angiotensin-aldosterone system inhibition in patients with chronic heart failure secondary to left ventricular systolic dysfunction

The prevalence of heart failure (HF) is high and still on the rise. In 2004, an estimated 5.2 million adults in the United States carried the diagnosis of HF with a mortality rate of > 19%. The incidence of HF is higher in individuals 65 years or older. As the US population grows older, the personal and economic costs of this disease are expected to grow. More than 75% of patients with HF have a history of hypertension, and blood pressure control can reduce the risk of serious cardiovascular events and death in this population. In addition to lowering blood pressure, blockade of the renin-angiotensin-aldosterone system can reduce the negative effects of chronic renin-angiotensin-aldosterone system activation on the progression of HF. This review discusses the clinical data supporting the use of angiotensin-converting enzyme inhibitors and angiotensin receptors blockers, alone or in combination, for improving outcomes in patients with HF. (Am Heart J20091-1 57:S17-S23.)