Publication
Neurohormonal modulation: The new paradigm of pharmacological treatment of heart failure
| dc.contributor.author | Silva-Cardoso, J | |
| dc.contributor.author | Brás, D | |
| dc.contributor.author | Canário-Almeida, F | |
| dc.contributor.author | Bragança, N, et al. | |
| dc.date.accessioned | 2019-04-30T14:46:42Z | |
| dc.date.available | 2019-04-30T14:46:42Z | |
| dc.date.issued | 2019 | |
| dc.description.abstract | The current paradigm of medical therapy for heart failure with reduced ejection fraction (HFrEF) is triple neurohormonal blockade with an angiotensin-converting enzyme inhibitor (ACEI), a beta-blocker (BB) and a mineralocorticoid receptor antagonist (MRA). However, three-year mortality remains over 30%. Stimulation of counter-regulatory systems in addition to neurohormonal blockade constitutes a new paradigm, termed neurohormonal modulation. Sacubitril/valsartan is the first element of this new strategy. PARADIGM-HF was the largest randomized clinical trial conducted in HFrEF. It included 8442 patients and compared the efficacy and safety of sacubitril/valsartan versus enalapril. The primary endpoint was the composite of cardiovascular mortality and hospitalization due to HF, which occurred in 914 (21.8%) patients receiving sacubitril/valsartan and in 1117 (26.5%) patients receiving enalapril (HR 0.8, 95% CI 0.73-0.87, p=0.0000002; NNT 21). Sacubitril/valsartan reduced both primary endpoint components, as well as sudden cardiac death, death due to worsening HF, and death from all causes. Patients on sacubitril/valsartan reported less frequent deterioration of HF and of quality of life, and discontinued study medication less frequently because of an adverse event. PARADIGM-HF demonstrated the superiority of sacubitril/valsartan over enalapril, with a 20% greater impact on cardiovascular mortality compared to ACEIs. Accordingly, in 2016, the European (ESC) and American (ACC/AHA/HFSA) cardiology societies simultaneously issued a class I recommendation for the replacement of ACEIs by sacubitril/valsartan in patients resembling PARADIGM-HF trial participants. | pt_PT |
| dc.description.version | info:eu-repo/semantics/publishedVersion | pt_PT |
| dc.identifier.citation | Rev Port Cardiol. 2019 Apr 24. pii: S0870-2551(18)30063-5 | pt_PT |
| dc.identifier.doi | 10.1016/j.repc.2018.10.011 | pt_PT |
| dc.identifier.issn | 2174-2030 | |
| dc.identifier.uri | http://hdl.handle.net/10400.10/2221 | |
| dc.language.iso | eng | pt_PT |
| dc.peerreviewed | yes | pt_PT |
| dc.publisher | Sociedade Portuguesa de Cardiologia | pt_PT |
| dc.relation.publisherversion | file://u_share/users/arminda.m.sustelo/Downloads/1-s2.0-S0870255118300635-main.pdf | pt_PT |
| dc.subject | Heart failure | pt_PT |
| dc.subject | Angiotensin receptor antagonists | pt_PT |
| dc.title | Neurohormonal modulation: The new paradigm of pharmacological treatment of heart failure | pt_PT |
| dc.type | journal article | |
| dspace.entity.type | Publication | |
| oaire.citation.conferencePlace | Lisboa | pt_PT |
| oaire.citation.title | Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia | pt_PT |
| rcaap.rights | openAccess | pt_PT |
| rcaap.type | article | pt_PT |