Pharmacological Treatment of Heart Failure with Preserved Ejection Fraction.
Pharmacological Treatment of Heart Failure with Preserved Ejection Fraction.
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DOI：
10.33160/yam.2017.06.001
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发表时间：
2017-06
影响因子：
1
通讯作者：
Kazuhiro Yamamoto
中科院分区：
文献类型：
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作者：
Kazuhiro Yamamoto
射血分数正常的心力衰竭是日本和其他发达国家的社会经济负担。利尿剂被广泛用于减轻射血分数保留和降低的心力衰竭的充血症状和体征，尽管由于设计随机和前瞻性临床试验的伦理困难，其对心力衰竭两种表型的长期预后的影响尚未得到证实。指南没有提供任何关于治疗选择的指导，在当前的临床环境中，医生在袢利尿剂中盲目选择呋塞米。然而，一些临床研究表明，袢利尿剂的效果并不一致，与其他袢利尿剂相比，呋塞米并不一定是首选。应注意袢利尿剂的选择。关于长期预后的改善，血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、盐皮质激素受体阻滞剂和β受体阻滞剂已被证明对射血分数降低的心力衰竭有效。然而，在临床试验中，这些药物都没有改善射血分数保留的心力衰竭的预后。临床试验的观察性研究和亚组分析表明，这些药物对心力衰竭的这种表型有益处。所有的临床试验和观察性研究都向我们提供了事实，让我们认识到，“一刀切”的方法可能是迄今为止缺乏射血分数保留心力衰竭治疗策略证据的原因。我们必须努力澄清射血分数正常的心力衰竭患者的特征，每种药物的给药是否会带来益处。
Heart failure with preserved ejection fraction is a socioeconomic burden in Japan as well as other developed countries. Diuretics are widely used to attenuate symptoms and signs of congestion in both heart failure with preserved and reduced ejection fraction, although their effects on long-term prognosis of both phenotypes of heart failure have not been demonstrated because of an ethical difficulty in designing a randomized and prospective clinical trial. Guidelines do not provide any guidance on therapy choice, and physicians blindly choose furosemide among loop diuretics in current clinical settings. However, several clinical studies have suggested that the effects of loop diuretics are not consistent, and that furosemide is not necessarily preferable as compared with other loop diuretics. We should pay attention to the choice of loop diuretics. Regarding the improvement of long-term prognosis, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, mineralocorticoid receptor blocker and β-blocker are proven effective for heart failure with reduced ejection fraction. However, none of these drugs have improved prognosis of heart failure with preserved ejection fraction in clinical trials. Observational studies and subanalysis of clinical trials suggest the benefits of these drugs in this phenotype of heart failure. All of clinical trials and observational studies present facts to us, and let us recognize that "one size fits all approach" may be a cause for a lack of evidence about the therapeutic strategy of heart failure with preserved ejection fraction until now. We have to make efforts to clarify characteristics of patients with heart failure and preserved ejection fraction to whom the administration of each drug provides benefits or do not.