Stage A: Can Heart Failure Be Prevented?
Ilya M. Danelich, Brent N. Reed and Carla A. Sueta
Affiliation: Clinical Pharmacist, Department of Pharmacy, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Keywords: ACE inhibitors, diet, diuretics, heart failure, hypertension, lifestyle, prevention, stage A.
Heart failure (HF) is an epidemic associated with significant morbidity and mortality, affecting over 5 million
people in the United States and 1-2% of the population worldwide. Observational studies have suggested that a healthy
lifestyle can reduce HF risk. Although no clinical trials have targeted the prevention of HF as a primary endpoint, many
have evaluated outcomes associated with the development of symptomatic disease (i.e., progression to HF, HF hospitalization
or death) as secondary endpoints. Blood pressure treatment represents the most effective strategy in preventing
heart failure; each 5 mm Hg decrease in systolic blood pressures reduces the risk of HF development by 24%. Thiazide
diuretics appear to be the most efficacious agents in patients with hypertension. Angiotensin converting enzyme inhibitors
and angiotensin-II receptor blockers are first line agents for patients with chronic atherosclerosis, diabetes, or chronic kidney
disease. Beta blockers appear less effective as single agents and cardioselective agents are preferred. Calcium channel
blockers, specifically non-dihydropyridines, should be avoided and alpha blockers should not be used to reduce HF risk.
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