AT(1) receptor antagonists-beyond blood pressure control: possible place in heart failure treatment.

The renin-angiotensin system (RAS) plays an important role in heart failure, and renin angiotensin aldosterone blockade has been shown to be of benefit in its treatment. The eVectiveness of angiotensin converting enzyme (ACE) inhibitors has been well established in major trials including CONSENSUS 1, SOLVD, and V-HeFT-II. More recently, the benefits of the aldosterone antagonist spironolactone have been demonstrated in the RALES trial. RAS blockade has also been of benefit in patients who have sustained a myocardial infarction, complicated by either left ventricular systolic dysfunction or by clinical signs of acute heart failure. This has been well documented in clinical trials, in particular SAVE, AIRE, and TRACE. Given the huge success of ACE inhibitors, it is not surprising that there is hope that angiotensin II type I (AT1) receptor antagonists might also have an important role in these patients. In assessing the potential role of AT1 antagonists there are three questions that need addressing: x Are AT1 antagonists better than placebo? x Are AT1 antagonists better than ACE inhibitors? x Should they be used in combination with ACE inhibitors?