Wilbert S. Aronow, MD, Divisions of Cardiology and Geriatrics, New York Medical College, Valhalla, NY, USA.
The American College of Cardiology/American Heart Association guidelines recommend that patients with asymptomatic left ventricular systolic dysfunction or with congestive heart failure (CHF) be treated with angiotensin-converting enzyme (ACE) inhibitors plus beta-blockers unless there are contraindications to the use of these drugs. Beta-blockers have been demonstrated to significantly reduce all-cause mortality associated with abnormal or normal left ventricular ejection fraction in older and younger patients with CHF. An angiotensin receptor blocker should not be administered to patients with CHF who are being treated with a beta-blocker plus ACE inhibitor, but should be given to patients with CHF treated with beta-blockers who cannot tolerate ACE inhibitors due to cough, angioneurotic edema, rash or altered taste sensation.
Key words: congestive heart failure, left ventricular ejection fraction, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptors blockers.
