Clinical Research in Cardiology

, Volume 95, Supplement 4, pp 36–56 | Cite as

Stand der medikamentösen Therapie bei chronischer Herzinsuffizienz

WEITERBILDUNG · ZERTIFIZIERTE FORTBILDUNG

Zusammenfassung

Die medikamentöse Therapie von Patienten mit chronischer Herzinsuffizienz wird aufgrund neuer Studien ständig verändert. Sie hat leitliniengetreu zu erfolgen. Neuerungen und der aktuelle Stand der Forschung sind in diesem Artikel wiedergegeben.

Schlüsselwörter

Chronische Herzinsuffizienz medikamentöse Behandlung Leitlinien 

Drug treatment of chronic heart failure

Summary

Drug treatment of chronic heart failure is undergoing continuous modifications according to the data of new trials. Treatment has to be adjusted to current guidelines. The state of the art of medical treatment of chronic heart failure is addressed in this report.

Key words

Chronic heart failure drug treatment guidelines 

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Literatur

  1. 1.
    Böhm M (2000) Definition der Herzinsuffizienz. In: Böhm M (Ed) Georg Thieme Verlag, Stuttgart-New York 1–4Google Scholar
  2. 2.
    The CONSENSUS Trial Study Group (1987) Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 316:1429–1435Google Scholar
  3. 3.
    The SOLVD Investigators (1991) Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 325:293–302Google Scholar
  4. 4.
    The SOLVD Investigators (1992) Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 327:685–691Google Scholar
  5. 5.
    Baruch L, Anand I, Cohen IS, Ziesche S, Judd D, Cohn JN (1999) Augmented short- and long-term hemodynamic and hormonal effects of an angiotensin receptor blocker added to angiotensin converting enzyme inhibitor therapy in patients with heart failure. Vasodilator Heart Failure Trial (V-HeFT) Study Group. Circulation 99:2658–2664PubMedGoogle Scholar
  6. 6.
    Cohn JN, Tognoni G (2001) A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 345:1667–1675CrossRefPubMedGoogle Scholar
  7. 7.
    Gerdts E, Oikarinen L, Palmieri V, Otterstad JE, Wachtell K, Boman K, Dahlof B, Devereux RB (2002) Correlates of left atrial size in hypertensive patients with left ventricular hypertrophy: the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study. Hypertension 39:739–743CrossRefPubMedGoogle Scholar
  8. 8.
    Granger CB, McMurray JJ, Yusuf S, Held P, Michelson EL, Olofsson B, Ostergren J, Pfeffer MA, Swedberg K (2003) Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARMAlternative trial. Lancet 362:772–776CrossRefPubMedGoogle Scholar
  9. 9.
    McKelvie RS, Yusuf S, Pericak D, Avezum A, Burns RJ, Probstfield J, Tsuyuki RT, White M, Rouleau J, Latini R, Maggioni A, Young J, Pogue J (1999) Comparison of candesartan, enalapril, and their combination in congestive heart failure: randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD Pilot Study Investigators. Circulation 100:1056–1064PubMedGoogle Scholar
  10. 10.
    McMurray JJ, Ostergren J, Swedberg K, Granger CB, Held P, Michelson EL, Olofsson B, Yusuf S, Pfeffer MA (2003) Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 362:767–771PubMedGoogle Scholar
  11. 11.
    Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ, Jr, Cuddy TE, Davis BR, Geltman EM, Goldman S, Flaker GC (1992) Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med 327:669–677PubMedGoogle Scholar
  12. 12.
    Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, Yusuf S, Pocock S (2003) Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARMOverall programme. Lancet 362:759–766PubMedGoogle Scholar
  13. 13.
    Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Kober L, Maggioni AP, Solomon SD, Swedberg K, Van De WF, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM (2003) Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 349:1893–1906CrossRefPubMedGoogle Scholar
  14. 14.
    Pitt B, Segal R, Martinez FA, Meurers G, Cowley AJ, Thomas I, Deedwania PC, Ney DE, Snavely DB, Chang PI (1997) Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE). Lancet 349:747–752PubMedGoogle Scholar
  15. 15.
    Pitt B, Poole-Wilson PA, Segal R, Martinez FA, Dickstein K, Camm AJ, Konstam MA, Riegger G, Klinger GH, Neaton J, Sharma D, Thiyagarajan B (2000) Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial—the Losartan Heart Failure Survival Study ELITE II. Lancet 355:1582–1587CrossRefPubMedGoogle Scholar
  16. 16.
    Wachtell K, Bella JN, Rokkedal J, Palmieri V, Papademetriou V, Dahlof B, Aalto T, Gerdts E, Devereux RB (2002) Change in diastolic left ventricular filling after one year of antihypertensive treatment: The Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study. Circulation 105:1071–1076CrossRefPubMedGoogle Scholar
  17. 17.
    Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G (2000) Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 342:145–153PubMedGoogle Scholar
  18. 18.
    Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J (2003) Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 362:777–781CrossRefPubMedGoogle Scholar
  19. 19.
    Flather MD, Shibata MC, Coats AJS, Van Veldhuisen DJ, Parkhomenko A, Borbola J, Cohen-Solal A, Dumitrascu D, Ferrari R, Lechat Ph, Soler-Soler J, Tavazzi L, Spinarova L, Toman J, Böhm M, Anker StD, Thompson SG, Poole-Wilson PhA on behalf of the SENIORS Investigators (2005) Fast-track randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure. European Heart Journal 26:215–225PubMedGoogle Scholar
  20. 20.
    Lin M, Sumimoto T, Hiwada K (1995) Left ventricular geometry and cardiac function in mild to moderate essential hypertension. Hypertens Res 18:151–157PubMedGoogle Scholar
  21. 21.
    Böhm M (2002) Pathophysiology of heart failure today. Herz 27:75–91PubMedGoogle Scholar
  22. 22.
    Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DA, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW (2005) ACC/AHA 2005 Guideline update for the diagnosis and management of chronic heart failure in the adult—summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). Circulation 112:1825–1852CrossRefGoogle Scholar
  23. 23.
    Hoppe UC, Böhm M, Dietz R, Hanrath P, Kroemer HK, Osterspey A, Schmaltz AA, Erdmann E (2005) Leitlinien zur Therapie der chronischen Herzinsuffizienz. Z Kardiol 94:488–509CrossRefPubMedGoogle Scholar
  24. 24.
    Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komajda M, Tavazzi L, Smiseth OA, Gavazzi A, Haverich A, Hoes A, Jaarsma T, Korewicki J, Lévy S, Linde C, Lopez-Sendon JL, Nieminen M, Piérard L, Remme WJ (2005) Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005). The task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology. Eur Heart J 26:1115–1140CrossRefPubMedGoogle Scholar
  25. 25.
    Kober L, Torp-Pedersen C, Carlsen JE, Bagger H, Eliasen P, Lyngborg K, Videbaek J, Cole DS, Auclert L, Pauly NC (1995) A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group. N Engl J Med 333:1670–1676CrossRefPubMedGoogle Scholar
  26. 26.
    The Captopril-Digoxin Multicenter Research Group (1988) Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure. JAMA 259:539–544Google Scholar
  27. 27.
    Cohn JN, Johnson G, Ziesche S, Cobb F, Francis G, Tristani F, Smith R, Dunkman WB, Loeb H, Wong M (1991) A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 325:303-310PubMedGoogle Scholar
  28. 28.
    Cohn JN, Tognoni G (2001) A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 345:1667–1675CrossRefPubMedGoogle Scholar
  29. 29.
    Teerlink JR, Massie BM (1999) Betaadrenergic blocker mortality trials in congestive heart failure. Am J Cardiol 84:94R–102RCrossRefPubMedGoogle Scholar
  30. 30.
    The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial (1999) Lancet 353:9–13Google Scholar
  31. 31.
    Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERITHF) (1999) Lancet353:2001–2007Google Scholar
  32. 32.
    Bristow MR, Gilbert EM, Abraham WT, Adams KF, Fowler MB, Hershberger RE, Kubo SH, Narahara KA, Ingersoll H, Krueger S, Young S, Shusterman N (1996) Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. MOCHA Investigators. Circulation 94:2807–2816PubMedGoogle Scholar
  33. 33.
    Colucci WS, Packer M, Bristow MR, Gilbert EM, Cohn JN, Fowler MB, Krueger SK, Hershberger R, Uretsky BF, Bowers JA, Sackner-Bernstein JD, Young ST, Holcslaw TL, Lukas MA (1996) Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure. US Carvedilol Heart Failure Study Group. Circulation 94:2800–2806PubMedGoogle Scholar
  34. 34.
    Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH (1996) The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med 334:1349–1355CrossRefPubMedGoogle Scholar
  35. 35.
    Poole-Wilson PA, Swedberg K, Cleland JG, Di Lenarda A, Hanrath P, Komajda M, Lubsen J, Lutiger B, Metra M, Remme WJ, Torp-Pedersen C, Scherhag A, Skene A (2003) Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet 362:7–13PubMedGoogle Scholar
  36. 36.
    Bayliss J, Norell M, Canepa-Anson R, Sutton G, Poole-Wilson P (1987) Untreated heart failure: clinical and neuroendocrine effects of introducing diuretics. Br Heart J 57:17–22PubMedGoogle Scholar
  37. 37.
    Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 341:709–717PubMedGoogle Scholar
  38. 38.
    Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, Bittman R, Hurley S, Kleiman J, Gatlin M (2003) Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 348:1309–1321CrossRefPubMedGoogle Scholar
  39. 39.
    Böhm M (2002) Are cardiac glycosides still needed in the treatment of cardiac insufficiency? Dtsch Med Wochenschr 127:2133–2138PubMedGoogle Scholar
  40. 40.
    The Digitalis Investigation Group (1997) The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 336:525–533Google Scholar
  41. 41.
    Rathore SS, Wang Y, Krumholz HM (2002) Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med 347:1403–1411CrossRefPubMedGoogle Scholar
  42. 42.
    Rathore SS, Curtis JP, Wang Y, Bristow MR, Krumholz HM (2003) Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA 289:871–878PubMedGoogle Scholar
  43. 43.
    Cohn JN, Archibald DG, Ziesche S, Franciosa JA, Harston WE, Tristani FE, Dunkman WB, Jacobs W, Francis GS, Flohr KH (1986) Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. N Engl J Med 314:1547–1552PubMedGoogle Scholar
  44. 44.
    Cohn J, Johnson G, Ziesche S, Cobb FR, Francis GS, Tristani FE, Smith R, Dunkman WB, Loeb HS, Wong M, Bhat G, Glogman S, Fletcher RD, Doherty J, Hughes CV, Carson P, Cintron G, Shabetai R, Haakenson C (1991) A comparison of enalapril with hydralazine-isosorbide dinitrate in treatment of chronic congestive heart failure. N Engl J Med 325:303–310PubMedGoogle Scholar
  45. 45.
    Taylor AL, Ziesche S, Yancy C, Carson P, D’Agostino R Jr, Ferdinand K, Taylor M, Adams K, Sabolinski M, Worcel M, Cohn JN (2004) Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med 351:2049–2057PubMedGoogle Scholar
  46. 46.
    The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (2002) Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 288:2981–2997Google Scholar
  47. 47.
    Cohn JN, Ziesche S, Smith R, Anand I, Dunkman WB, Loeb H, Cintron G, Boden W, Baruch L, Rochin P, Loss L (1997) The effect of the calcium antagonist felodipine as supplementary vasodilator therapy in patients with chronic heart failure. Circulation 96:856–863PubMedGoogle Scholar
  48. 48.
    Packer M, O’Conner Ch M, Ghali JK, Pressler ML, Carson PE, Belkin RN, Miller AB, Neuberg GW, Frid D, Wertheimer JH, Cropp AB, DeMets DL, for the prospective randomized amlopidine survival evaluation study group (1996) Effect of amlodipine on morbidity and mortality in severe chronic heart failure. N Engl J Med 335:1107–1114CrossRefPubMedGoogle Scholar
  49. 49.
    The Danish Verapamil Infarction Trial II-(DAVIT II) (1990) Effect of verapamil on mortality and major events after acute myocardial infarction. Am J Cardiol 66:779–785Google Scholar
  50. 50.
    Goldbourt U, Behar S, Reicher-Reiss H, Zion M, Mandelzweig L, Kaplinsky E (1993) Early administration of nifedipine in suspected acute myocardial infarction. The Secondary Prevention Reinfarction Israel Nifedipine Trial 2 Study. Arch Intern Med 153:345–353CrossRefPubMedGoogle Scholar
  51. 51.
    The Israeli Sprint Study Group (1988) Secondary prevention reinfarction Israeli nifedipine trial (SPRINT). A randomized intervention trial of nifedipine in patients with acute myocardial infarction. Eur Heart J 9:354–364Google Scholar

Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  1. 1.Universitätsklinikum des Saarlandes, Klinik für Innere Medizin IIIHomburg/Saar
  2. 2.Universitätsklinikum des Saarlandes, Klinik für Innere Medizin IIIHomburg/Saar
  3. 3.Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik IIBonn

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