Time and Technology Will Tell : The Pathophysiologic Basis of Neurohormonal Modulation in Heart Failure - 12/09/14

Doi : 10.1016/j.hfc.2014.07.002

Brent N. Reed, PharmD ^a,^{^{1
These authors contributed equally.}}, Sarah E. Street, PhD ^b,^{^{1
These authors contributed equally.}}, Brian C. Jensen, MD ^c,^⁎
^a Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, 20 North Pine Street, Baltimore, MD 21201, USA
^b Department of Cell Biology and Physiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
^c Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, 160 Dental Circle, Chapel Hill, NC 27599-7075, USA

^∗Corresponding author.

Résumé

The central roles of neurohormonal abnormalities in the pathobiology of heart failure have been defined in recent decades. Experiments have revealed both systemic involvement and intricate subcellular regulation by circulating effectors of the sympathetic nervous system, the renin-angiotensin-aldosterone system, and others. Randomized clinical trials substantiated these findings, establishing neurohormonal antagonists as cornerstones of heart failure pharmacotherapy, and occasionally offering further insight on mode of benefit. This review discusses the use of β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone receptor antagonists in the treatment of heart failure, with particular attention to the pathophysiologic basis and mechanisms of action.

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Keywords : Heart failure, Sympathetic nervous system, Renin-angiotensin system, Drug therapy, Physiology, Neurotransmitter agents, Adrenergic beta-antagonists, Angiotensin-converting enzyme inhibitors