Eplerenone Another Drug to Add to the Mix? ∗

Digoxin and diuretics have been used for centuries to treat the symptoms of heart failure. Yet, it was the addition of angiotensin-converting enzyme (ACE) inhibitors that revolutionized the management of chronic heart failure by demonstrating an astonishing 40% reduction in 6-month mortality when compared to placebo in the original CONSENSUS (Cooperative North Scandinavian Enalapril Survival Study) (1). The evolution of evidence-based therapies makes it difficult to study new treatments without established background therapy. Thus, beta-blockers were studied in patients already treated with ACE inhibitors; other drugs such as angiotensin receptor antagonists and the combination of hydralazine and isosorbide dinitrate were studied in patients already treated with ACE inhibitors and beta-blockers. As a result of this evolution of evidence-based therapies, heart failure patients are now treated with a cocktail of medications often including ACE inhibitors, beta-blockers, digoxin, diuretics, aspirin, statins, and in some cases hydralazine and isosorbide dinitrate. These medications, in addition to medications used to treat concomitant conditions such as coronary artery disease, diabetes, and kidney disease, add to the expense of therapy and increase the likelihood for drug interactions, drug-related adverse effects (AEs), and noncompliance.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - Category: Cardiology Source Type: research