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Aamer H. Jamali, MD; W. H. Wilson Tang, MD; Umesh N. Khot, MD; Michael B. Fowler, MB, FRCP

Arch Intern Med. 2001;161:667-672.

Clinical and basic science research has repeatedly confirmed the importance of the renin-angiotensin-aldosterone system in the pathophysiology of chronic heart failure. Accordingly, blockade of this system by angiotensin-converting enzyme (ACE) inhibitors has assumed a central role in the treatment of heart failure. Recently, angiotensin II receptor blockers (ARBs) have gained prominence as a possible substitute for ACE inhibitors in therapy for heart failure. However, clinical data compiled on this use of ARBs have shown them to be useful only as alternative therapy in ACE inhibitor–intolerant patients. Continuing large-scale clinical investigations may lead to an expansion of their role in therapy for various cardiovascular diseases.

From the Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif (Drs Jamali, Tang, and Fowler), and the Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio (Dr Khot). Dr Fowler has received grant and research support from SmithKline Beecham Pharmaceuticals, Merck & Co, Inc, and Novartis; has acted as a consultant to SmithKline Beecham Pharmaceuticals, Merck & Co, Inc, and Bristol Myers; and has participated in the speakers bureaus of Astra Zeneca, Roche, SmithKline Beecham, and Merck & Co, Inc.

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