Angiotensin II Receptor Blockers in the Treatment of Heart Failure

Ross C. Peterson, MD, Mark E. Dunlap, MD


CHF. 2002;8(5) 

In This Article


Despite the benefits of proven therapy for heart failure, mortality remains high, with approximately 50% of patients dead at 5 years.[49] Although ACE inhibitors decrease mortality, they incompletely suppress angiotensin II with chronic therapy. Since ARBs block the biologic effects of angiotensin II more completely than ACE inhibitors, they could be beneficial in the treatment of heart failure.

In a direct comparison trial (ELITE-II), ARBs were found to have no benefit over ACE inhibitor therapy. Thus, ACE inhibitors should remain first-line treatment for heart failure. However, for patients who are truly ACE inhibitor-intolerant, ARB therapy is a reasonable substitute and provides excellent tolerability. In patients already on ACE inhibitor therapy, the addition of an ARB reduced the number of heart failure hospitalizations (Val-HeFT). Therefore, ARBs can safely be added to ACE inhibitor therapy in patients who remain symptomatic. The caveat is that patients on ACE inhibitors and blockers did not appear to benefit from the ARB. For patients on ACE inhibitors and not blockers, the addition of a blocker is preferred over an ARB, since multiple studies have shown a mortality benefit in heart failure patients taking blockers. The CHARM study should help to delineate the use of ARBs as either ACE inhibitor add-on or substitute therapy in patients with heart failure.