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    Combination of Drugs for Heart Failure May Be Best

    The past decade has seen so many new approaches to treating congestive heart failure that both doctors and patients may be wondering what's really best. In particular, there has been a lot of debate over the relative importance of two kinds of drugs: ACE inhibitors, which reduce blood pressure by suppressing the angiotensin converting enzyme that regulates it; and beta blockers, which reduce the stress on the heart by suppressing the hormone adrenaline, slowing the heart rate and lowering blood pressure.

    The answer: Use both to manage patients with congestive heart failure, says Mandeep Mehra, M.D., of the Ochsner Clinic in New Orleans, and a specialist in heart failure and cardiac transplants. "With ACE inhibitors, we stop [patients] from getting worse. With beta blockers on top of ACE inhibitors, we actually start to decrease the amount of ventricular dysfunction."

    Mehra was speaking to a group of physicians at the annual meeting of the American College of Physicians/American Society for Internal Medicine, in Philadelphia this week. He explained that even when the symptoms of heart failure are controlled with ACE inhibitors, patients with this condition are at a high risk of dying because of the underlying heart problems.

    "Heart failure can be a silent disorder," says Mehra. Because the cardiovascular system is good at compensating for problems, sometimes patients won't show any symptoms of heart failure, even though the functioning of the ventricles is dangerously impaired.

    "Heart failure limits functional capacity and impairs quality of life," said Mehra. "Plus, it's a progressive disease, with worsening symptoms and deterioration that eventually leads to death." The key to preventing death from this condition, he explained, is to keep heart function from getting worse. And the best way to do that is to use both ACE inhibitors and beta blockers.

    While research data are clear that ACE inhibitors reduce the rate of complications and death from heart failure, "about 30 to 40 percent of patients with heart failure will still die within four years," stated Mehra. And that's where the beta blockers come in.

    Recent clinical studies have shown that controlling the hormone adrenaline plays an important role in heart function, Mehra explained. Beta blockers, which suppress this hormone, "clearly improved outcomes in all major trials," by decreasing subsequent hospitalizations and increasing survival.

    Mehra said that using both drugs cannot only improve symptoms of heart failure, but reduce morbidity and mortality -- other diseases and death -- by as much as 40 percent, according to recent research findings.

    While the use of the two drugs together requires careful monitoring for side effects, research results suggest that the effort is well worth it in terms of keeping patients with heart failure alive and well.


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