Modulação neuro-hormonal
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10362/148214 |
Resumo: | The current paradigm of medical therapy for heart failure with reduced ejection fraction (HFrEF) is triple neurohormonal blockade with an angiotensin-converting enzyme inhibitor (ACEI), a beta-blocker (BB) and a mineralocorticoid receptor antagonist (MRA). However, three-year mortality remains over 30%. Stimulation of counter-regulatory systems in addition to neurohormonal blockade constitutes a new paradigm, termed neurohormonal modulation. Sacubitril/valsartan is the first element of this new strategy. PARADIGM-HF was the largest randomized clinical trial conducted in HFrEF. It included 8442 patients and compared the efficacy and safety of sacubitril/valsartan versus enalapril. The primary endpoint was the composite of cardiovascular mortality and hospitalization due to HF, which occurred in 914 (21.8%) patients receiving sacubitril/valsartan and in 1117 (26.5%) patients receiving enalapril (HR 0.8, 95% CI 0.73-0.87, p=0.0000002; NNT 21). Sacubitril/valsartan reduced both primary endpoint components, as well as sudden cardiac death, death due to worsening HF, and death from all causes. Patients on sacubitril/valsartan reported less frequent deterioration of HF and of quality of life, and discontinued study medication less frequently because of an adverse event. PARADIGM-HF demonstrated the superiority of sacubitril/valsartan over enalapril, with a 20% greater impact on cardiovascular mortality compared to ACEIs. Accordingly, in 2016, the European (ESC) and American (ACC/AHA/HFSA) cardiology societies simultaneously issued a class I recommendation for the replacement of ACEIs by sacubitril/valsartan in patients resembling PARADIGM-HF trial participants. |
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Modulação neuro-hormonalNeurohormonal modulationThe new paradigm of pharmacological treatment of heart failureo novo paradigma do tratamento farmacológico da Insuficiência CardíacaAngiotensin-receptor neprilysin inhibitorCardiovascular mortalityHeart failure with reduced ejection fractionHospitalization due to heart failureNeurohormonal modulationPARADIGM-HFSacubitril/valsartanCardiology and Cardiovascular MedicineThe current paradigm of medical therapy for heart failure with reduced ejection fraction (HFrEF) is triple neurohormonal blockade with an angiotensin-converting enzyme inhibitor (ACEI), a beta-blocker (BB) and a mineralocorticoid receptor antagonist (MRA). However, three-year mortality remains over 30%. Stimulation of counter-regulatory systems in addition to neurohormonal blockade constitutes a new paradigm, termed neurohormonal modulation. Sacubitril/valsartan is the first element of this new strategy. PARADIGM-HF was the largest randomized clinical trial conducted in HFrEF. It included 8442 patients and compared the efficacy and safety of sacubitril/valsartan versus enalapril. The primary endpoint was the composite of cardiovascular mortality and hospitalization due to HF, which occurred in 914 (21.8%) patients receiving sacubitril/valsartan and in 1117 (26.5%) patients receiving enalapril (HR 0.8, 95% CI 0.73-0.87, p=0.0000002; NNT 21). Sacubitril/valsartan reduced both primary endpoint components, as well as sudden cardiac death, death due to worsening HF, and death from all causes. Patients on sacubitril/valsartan reported less frequent deterioration of HF and of quality of life, and discontinued study medication less frequently because of an adverse event. PARADIGM-HF demonstrated the superiority of sacubitril/valsartan over enalapril, with a 20% greater impact on cardiovascular mortality compared to ACEIs. Accordingly, in 2016, the European (ESC) and American (ACC/AHA/HFSA) cardiology societies simultaneously issued a class I recommendation for the replacement of ACEIs by sacubitril/valsartan in patients resembling PARADIGM-HF trial participants.NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)RUNSilva-Cardoso, J.Brás, D.Canário-Almeida, F.Andrade, A.Oliveira, L.Pádua, F.Fonseca, C.Bragança, N.Carvalho, S.Soares, R.Santos, J. Ferreira2023-01-26T22:11:05Z2019-032019-03-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10362/148214por0870-2551PURE: 12985226https://doi.org/10.1016/j.repc.2018.10.011info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T05:29:36Zoai:run.unl.pt:10362/148214Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:53:16.613344Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Modulação neuro-hormonal Neurohormonal modulationThe new paradigm of pharmacological treatment of heart failure o novo paradigma do tratamento farmacológico da Insuficiência Cardíaca |
title |
Modulação neuro-hormonal |
spellingShingle |
Modulação neuro-hormonal Silva-Cardoso, J. Angiotensin-receptor neprilysin inhibitor Cardiovascular mortality Heart failure with reduced ejection fraction Hospitalization due to heart failure Neurohormonal modulation PARADIGM-HF Sacubitril/valsartan Cardiology and Cardiovascular Medicine |
title_short |
Modulação neuro-hormonal |
title_full |
Modulação neuro-hormonal |
title_fullStr |
Modulação neuro-hormonal |
title_full_unstemmed |
Modulação neuro-hormonal |
title_sort |
Modulação neuro-hormonal |
author |
Silva-Cardoso, J. |
author_facet |
Silva-Cardoso, J. Brás, D. Canário-Almeida, F. Andrade, A. Oliveira, L. Pádua, F. Fonseca, C. Bragança, N. Carvalho, S. Soares, R. Santos, J. Ferreira |
author_role |
author |
author2 |
Brás, D. Canário-Almeida, F. Andrade, A. Oliveira, L. Pádua, F. Fonseca, C. Bragança, N. Carvalho, S. Soares, R. Santos, J. Ferreira |
author2_role |
author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM) RUN |
dc.contributor.author.fl_str_mv |
Silva-Cardoso, J. Brás, D. Canário-Almeida, F. Andrade, A. Oliveira, L. Pádua, F. Fonseca, C. Bragança, N. Carvalho, S. Soares, R. Santos, J. Ferreira |
dc.subject.por.fl_str_mv |
Angiotensin-receptor neprilysin inhibitor Cardiovascular mortality Heart failure with reduced ejection fraction Hospitalization due to heart failure Neurohormonal modulation PARADIGM-HF Sacubitril/valsartan Cardiology and Cardiovascular Medicine |
topic |
Angiotensin-receptor neprilysin inhibitor Cardiovascular mortality Heart failure with reduced ejection fraction Hospitalization due to heart failure Neurohormonal modulation PARADIGM-HF Sacubitril/valsartan Cardiology and Cardiovascular Medicine |
description |
The current paradigm of medical therapy for heart failure with reduced ejection fraction (HFrEF) is triple neurohormonal blockade with an angiotensin-converting enzyme inhibitor (ACEI), a beta-blocker (BB) and a mineralocorticoid receptor antagonist (MRA). However, three-year mortality remains over 30%. Stimulation of counter-regulatory systems in addition to neurohormonal blockade constitutes a new paradigm, termed neurohormonal modulation. Sacubitril/valsartan is the first element of this new strategy. PARADIGM-HF was the largest randomized clinical trial conducted in HFrEF. It included 8442 patients and compared the efficacy and safety of sacubitril/valsartan versus enalapril. The primary endpoint was the composite of cardiovascular mortality and hospitalization due to HF, which occurred in 914 (21.8%) patients receiving sacubitril/valsartan and in 1117 (26.5%) patients receiving enalapril (HR 0.8, 95% CI 0.73-0.87, p=0.0000002; NNT 21). Sacubitril/valsartan reduced both primary endpoint components, as well as sudden cardiac death, death due to worsening HF, and death from all causes. Patients on sacubitril/valsartan reported less frequent deterioration of HF and of quality of life, and discontinued study medication less frequently because of an adverse event. PARADIGM-HF demonstrated the superiority of sacubitril/valsartan over enalapril, with a 20% greater impact on cardiovascular mortality compared to ACEIs. Accordingly, in 2016, the European (ESC) and American (ACC/AHA/HFSA) cardiology societies simultaneously issued a class I recommendation for the replacement of ACEIs by sacubitril/valsartan in patients resembling PARADIGM-HF trial participants. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-03 2019-03-01T00:00:00Z 2023-01-26T22:11:05Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10362/148214 |
url |
http://hdl.handle.net/10362/148214 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
0870-2551 PURE: 12985226 https://doi.org/10.1016/j.repc.2018.10.011 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.source.none.fl_str_mv |
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