Monitoring Pulmonary Hypertension to Guide Treatment and Using Sacubitril/Valsartan to Treat Heart Failure Saves Lives

SEPTEMBER 20, 2016
W. Todd Penberthy,PhD
At the 2016 annual meeting of the Heart Failure Society of America, Milton Packer, MD, Distinguished Scholar in Cardiovascular Science, Baylor University Medical Center at Dallas, provided an update on recent developments in the pharmaceutical treatment of heart failure (HF) with reduced ejection fraction.
He started by critically noting that there is actually very little new when it comes to reduced ejection fraction HF drugs. The main options in widespread use continue to be diuretics, inhibitors of the renin-angiotensin system, inhibitors of the sympathetic nervous system (beta blockers), or aldosterone antagonists. Packer emphasized, “It is amazing that the cornerstone treatment of HF therapy, diuretics, turns out to be one of the least studied. Most importantly, we have no idea how to dose diuretics. If you get 10 different physicians, you are likely to find 10 different diuretic regimens. You might say, ‘Well, what guides that thinking process?’ and the answer is ‘I don’t know!’”
At the most basic level of understanding, Packer said that pulmonary artery hypertension is not just the result of fluid retention, but also fluid redistribution. In the days immediately preceding HF hospitalization, there is actually more often a redistribution of fluids than there is an edematous overt increase in fluid retention (the latter detectable as an increase in weight). Patients equipped with pulmonary artery sensors in randomized trials had a lower risk of heart failure than patients under the care of physicians who did not have access to pulmonary artery sensors.

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