Table of Contents
ISRN Cardiology
Volume 2014 (2014), Article ID 652421, 7 pages
http://dx.doi.org/10.1155/2014/652421
Review Article

Angiotensin Receptor Antagonists to Prevent Sudden Death in Heart Failure: Does the Dose Matter?

1Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University, Via di Grottarossa 1035-39, 00189 Rome, Italy
2I.R.C.C.S. Neuromed, Pozzilli, Italy

Received 4 October 2013; Accepted 1 December 2013; Published 6 February 2014

Academic Editors: W. Bloch, Y. Levy, P. S. Rahko, and J. S. Steinberg

Copyright © 2014 Pietro Francia et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

International guidelines recommend ICD implantation in patients with severe left ventricular dysfunction of any origin only after careful optimization of medical therapy. Indeed, major randomized clinical trials suggest that suboptimal use of fundamental drugs, such as ACE inhibitors (ACE-i) and beta-blockers, may affect ICD shock-free survival, sudden cardiac death (SCD), and overall mortality. While solid evidence in favour of pharmacological therapy based on ACE-i with or without beta-blockers is available, data on SCD in HF patients treated with angiotensin receptor blockers (ARBs) are limited. The present paper systematically analyses the impact of ARBs on SCD in HF and reviews the contributory role of the renin-angiotensin system (RAS) to the establishment of arrhythmic substrates. The following hypothesis is supported: (1) the RAS is a critical component of the electrical remodelling of the failing myocardium, (2) RAS blockade reduces the risk of SCD, and (3) ARBs represent a powerful tool to improve overall survival and possibly reduce the risk of SCD provided that high doses are employed to achieve optimal AT1-receptor blockade.