Renin-Angiotensin-Aldosterone System Blockade for HF: More Is Not Better

Adding a direct renin inhibitor to standard medical treatments failed to improve clinical outcomes.

Several drugs that block the renin-angiotensin-aldosterone system —angiotensin-converting–enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs) — are efficacious in patients with systolic heart failure (HF). Nonetheless, morbidity and mortality remain high, which is attributed at least in part to compensatory increases in renin stemming from aggressive neurohormonal antagonism. To assess the efficacy of augmenting standard medical therapy with the direct renin inhibitor aliskiren, investigators for the manufacturer-sponsored, double-blind ASTRONAUT trial randomized 1639 patients with systolic HF (mean age, 65; 77% men; mean left ventricular ejection fraction, 28%) hospitalized with …

Reviewing Author

Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)

Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)

Renin-Angiotensin-Aldosterone System Blockade for HF: More Is Not Better

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Reviewing Author