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DOI: 10.1055/s-2003-38225
© Georg Thieme Verlag Stuttgart · New York
ACE-Hemmer oder AT1-Antagonisten
Wann eignet sich welche Substanz?ACE-Inhibitors or AT1-AntagonistsWhen to Use Them?Publication History
Publication Date:
26 March 2003 (online)
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Zusammenfassung
Trotz mehrerer größerer klinischer Studien sind heute ACE-Hemmer immer noch Medikament der ersten Wahl bei der Behandlung der Herzinsuffizienz. AT1-Antagonisten sind den ACE-Hemmern dabei nicht überlegen - weder bei der Behandlung der chronischen Herzinsuffizienz noch bei der akuten Herzinsuffizienz im Rahmen eines Myokardinfarktes. Obwohl die Gleichwertigkeit beider Substanzgruppen noch nicht eindeutig bewiesen werden konnte, sind vermutlich AT1-Antagonisten ebenso wirksam wie ACE-Hemmer, weshalb sie bei einer Intoleranz gegenüber ACE-Hemmern eingesetzt werden sollten. Ihre Kombination sollte nur bei therapieresistenter Herzinsuffizienz erwogen werden. Noch nicht klar ist, wie sicher und wie effektiv eine Kombination von ACE-Hemmer, AT1-Antagonist und Beta-Blocker ist. Werden Patienten bereits mit einem Beta-Blocker behandelt, sollten sie daher nicht zusätzlich mit ACE-Hemmer und AT1-Antagonist gleichzeitig behandelt werden.
Summary
ACE-inhibitors are still the primary treatment in patients with heart failure - in spite of several large clinical trials with AT1-antagonists, which are not superior to ACE-inhibitors. This is true for the treatment of chronic heart failure as well as for acute heart failure complicating an acute myocardial infarction. Even though not clearly proven, AT1-antagonists seem to be as effective as ACE-inhibitors. They are the alternative treatment when intolerance to ACE-inhibitors is suspected. The combination of AT1-antagonists with ACE-inhibitors should be considered in symptomatic heart failure patients in spite of ACE-inhibitors in order to improve symptoms and decrease hospitalisation rate. If patients are on betablocker therapy (what is highly recommended), the combination with AT1-antagonists and ACE-inhibitors is not recommended.
Key Words
AT1-antagonists - ACE-inhibitors - heart failure - combination therapy
Literatur
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Anschrift für die Verfasser
PD Dr. Roland Willenbrock
Medizinische Klinik II
Krankenhaus St. Elisabeth und St. Barbara
Mauerstr. 5
06110 Halle/Saale