TY - JOUR
T1 - Present and future pharmacotherapeutic agents in heart failure: An evolving paradigm
AU - Madhani, Melanie
AU - Noordali, Hannah
AU - Frenneaux, Michael
AU - Loudon, Brodie
AU - Gollop, Nicholas D.
PY - 2016/6
Y1 - 2016/6
N2 - Many conditions culminate in heart failure (HF), a multi-organ systemic syndrome with an intrinsically poor prognosis. Pharmacotherapeutic agents that correct neurohormonal dysregulation and haemodynamic instability have occupied the forefront of developments within the treatment of HF in the past. Indeed, multiple trials aimed to validate these agents in the 1980s and early 1990s, resulting in a large and robust evidence base supporting their use clinically. An established treatment paradigm now exists for the treatment of HF with reduced ejection fraction, but there have been very few notable developments in recent years. HF remains a significant health concern with an increasing incidence as the population ages. We may indeed be entering the surgical era for HF treatment, but these therapies remain expensive and inaccessible to many. Newer pharmacotherapeutic agents are slowly emerging, investigating alternative therapeutic targets, but with mixed results. Metabolic modulation and manipulation of the Nitrate/Nitrite/nitric oxide pathway have shown promise and could provide the answers to fill the therapeutic gap between medical interventions and surgery, but further definitive trials are warranted. We review the significant evidence base behind the current medical treatments for HFrEF, the physiology of metabolic impairment in HF and discuss two promising novel agents, perhexiline and nitrite.
AB - Many conditions culminate in heart failure (HF), a multi-organ systemic syndrome with an intrinsically poor prognosis. Pharmacotherapeutic agents that correct neurohormonal dysregulation and haemodynamic instability have occupied the forefront of developments within the treatment of HF in the past. Indeed, multiple trials aimed to validate these agents in the 1980s and early 1990s, resulting in a large and robust evidence base supporting their use clinically. An established treatment paradigm now exists for the treatment of HF with reduced ejection fraction, but there have been very few notable developments in recent years. HF remains a significant health concern with an increasing incidence as the population ages. We may indeed be entering the surgical era for HF treatment, but these therapies remain expensive and inaccessible to many. Newer pharmacotherapeutic agents are slowly emerging, investigating alternative therapeutic targets, but with mixed results. Metabolic modulation and manipulation of the Nitrate/Nitrite/nitric oxide pathway have shown promise and could provide the answers to fill the therapeutic gap between medical interventions and surgery, but further definitive trials are warranted. We review the significant evidence base behind the current medical treatments for HFrEF, the physiology of metabolic impairment in HF and discuss two promising novel agents, perhexiline and nitrite.
U2 - 10.1111/bph.13480
DO - 10.1111/bph.13480
M3 - Article
SN - 0007-1188
VL - 173
SP - 1911
EP - 1924
JO - British Journal of Pharmacology
JF - British Journal of Pharmacology
IS - 12
ER -