A Clinician’s Commentary on Heart Failure Treatment in the Future

Author: Conti, C. Richard

Standard Therapy for Heart Failure

Until now the principal focus of heart failure therapy has been on the sympathetic nervous system and the renin-angiotensin system. Beta blockade counters the unwanted effects of catecholamines on the myocardium as well as moderately reducing afterload. Since angiotensin is a vasoconstrictor and has some toxic effect on the myocardium, both contributing to heart failure, inhibition of the renin–angiotensin system has been logical therapy for heart failure. However, use of angiotensin-converting enzyme (ACE) inhibitors may increase bradykinin levels, which are responsible for the cough that may be associated with their use as well as angioedema that may result from the same medications.

A New Drug for Heart Failure

At long last a new drug for heart failure with a different mechanism of action has come on the scene to treat the heart failure patient. This new drug blocks the enzyme neprilysin, which is expressed in a variety of tissues and degrades several endogenous vasoactive (vasodilator) peptides. The inhibition of neprilysin increases the levels of these vasodilator peptides. When vasodilation occurs as a result of this new compound, bradykinin levels are not increased and thus cough and angioedema may not occur.

DOI: http://dx.doi.org/10.15212/CVIA.2015.0001