New possibilities for heart failure and hypertension therapy
Authors:
Prof. MUDr. Jiří Vítovec, CSc.; Fesc 1; prof. MUDr. Lenka Špinarová, Ph.D.; Fesc 1; prof. MUDr. Jindřich Špinar, CSc.; Fesc 2
Authors‘ workplace:
Mezinárodní centrum klinického výzkumu –
I. interní kardio-angiologická klinika LF MU
a FN u sv. Anny v Brně
1; Interní kardiologická klinika LF MU a FN Brno
jiri. vitovec@fnusa. cz
2
Published in:
Kardiol Rev Int Med 2013, 15(2): 113-117
Category:
Overview
The therapy for reducing heart failure and hypertension has been extended by new medicines that mainly affect vasodilation. The first medicine is a dual inhibition of angiotensine II receptors (ARB) and neprilysin (NEP). It is currently, both experimentally and clinically, being tested for use in hypertension and heart failure therapy. It is based on the positive clinical effects of ARB and inhibition of vasoactive natriuretic peptides breakdown. The first large clinical trial of hypertension therapy showed sufficient hypotensive effect of LCZ 696 in heart failure with preserved ejection fraction. LCZ 696 significantly reduced the concentration of NT- proBNP. Another medicine is serelaxin (RLX030), the first recombinant form of the human hormone relaxin‑2. During pregnancy, relaxin modulates cardiovascular response with vasodilation and improves renal function. Its effect has been studied in acute heart failure, Pre‑RELAX- AHF and RELAX- AHF trials, which demonstrated favourable hemodynamic effects and also reduction in the 180- day mortality.
Keywords:
hypertension – heart failure – LCZ 696 – serelaxin
Sources
1. Vítovec J, Špinar J. Farmakoterapie kardiovaskulárních onemocnění. 2. přeprac. a dopl. vyd. Praha: Grada Publishing 2004.
2. Špinarová L, Špinar J, Vítovec J. Léčba natriuretickými peptidy – konec mýtu? Remedie 2011; 21: 78– 81.
3. Kostis JB, Packer M, Black HR et al. Omapatrilat and enalapril in patients with hypertension: the Omapatrilat Cardiovascular Treatment vs. Enalapril (OCTAVE) trial. Am J Hypertens 2004; 17: 103– 111.
4. Packer M, Califf RM, Konstam MA et al. Comparison of omapatrilat and enalapril in patients with chronic heart failure: the Omapatrilat versus Enalapril Randomized Trial of Utility in Reducing Events (OVERTURE). Circulation 2002; 106: 920– 926.
5. Gu J, Noe A, Chandra P et al. Pharmacokinetics and pharmacodynamics of LCZ696, a novel dualacting angiotensin receptor- neprilysin inhibitor (ARNI). J Clin Pharmacol 2010; 50: 401– 414.
6. Waeber B, Feihl F. Blood- pressure reduction with LCZ696. Lancet 2010; 375: 1228– 1229.
7. Ruilope LM, Dukat A, Böhm M et al. Blood- pressure reduction with LCZ696, a novel dual- acting inhibitor of the angiotensin II receptor and neprilysin: a randomised, double‑blind, placebo-controlled, active comparator study. Lancet 2010; 375: 1255– 1266.
8. Kobalava Z, Pavlikova E, Averkov O. First experience with concomitant AT1 and neprilysin (NEP 24.11) inhibition with LCZ696 in patients with chronic heart failure. Circulation 2010; 122: Abstract 19378.
9. Solomon SD, Zile M, Pieske B et al. Prospective comparison of ARNI with ARB on Management Of heart failUre with preserved ejectioN fracTion (PARAMOUNT) Investigators. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double‑blind randomised controlled trial. Lancet 2012; 380: 1387– 1395. doi:10.1016/ S0140- 6736(12)61227– 6.
10. McMurray JJV, Packer M, Desai AS et al. PARADIGM- HF Committees and Investigators. Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin‑converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM- HF). Eur J Heart Fail 2013 [online]. http:/ / eurjhf.oxfordjournals.org/ content/ early/ 2013/ 04/ 04/ eurjhf.hft052.short. doi:10.1093/ eurjhf/ hft052.
11. Jeyabalan A, Shroff SG, Novak J et al. The vascular actions of relaxin. Adv Exp Med Biol 2007; 612: 65– 87.
12. Teerlink JR, Metra M, Felker GM et al. Relaxin for the treatment of patients with acute heart failure (Pre‑RELAX- AHF): a multicentre, randomised, placebo- controlled, parallel- group, dose‑finding phase IIb study. Lancet 2009; 373: 1429– 1439.
13. Teerlink JR, Cotter G, Davison BA et al. RELAXin in Acute Heart Failure (RELAX- AHF) Investigators. Serelaxin, recombinant human relaxin‑2, for treatment of acute heart failure (RELAX- AHF): a randomised, placebo- controlled trial. Lancet 2013; 381: 29– 39.
14. Metra M, Cotter G, Davison BA et al. RELAX- AHF Investigators. Effect of serelaxin on cardiac, renal, and hepatic biomarkers in the relaxin in acute heart failure (relax- ahf) development program: correlation with outcomes. J Am Coll Cardiol 2013; 61: 196– 206.
15. Flipper e nuvola. Serelaxin for treatment of acute heart failure. Item detail. http:/ / flipper.diff.org/ app/ items/ info/ 5178.
16. Metra M, Cotter G, Davison BA et al. Effect of serelaxin on cardiac, renal, and hepatic biomarkers in the relaxin in acute heart failure (RELAX- AHF) development program: correlation with outcomes FREE. J Am Coll Cardiol 2013; 61: 196– 206. doi:10.1016/ j.jacc.2012.11.005.
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Paediatric cardiology Internal medicine Cardiac surgery CardiologyArticle was published in
Cardiology Review
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