Diastolic heart failure hospitalization

The combined use of ACE inhibitors and ARBs in the treatment of heart failure offers the intriguing possibility of additive therapeutic benefit by virtue of distinctive modes of angiotensin antagonism. Some experts suggest that the addition of an AT blocker to a heart failure regimen that includes an ACE inhibitor can be considered in an effort to reduce hospitalizations. ATj antagonists also appear to reduce hospitalization in patients with diastolic heart failure. 

In addition to data on the effects of /S-blockers on survival, there are data showing improvements in numerous other end points. All the large clinical trials have shown /3-blockers to produce 15% to 20% reductions in all-cause hospitalization and 25% to 35% reductions in hospitalizations for worsening heart failure. The positive effects of -blockers on the left ventricle systolic function also have been very consistent across studies. Following several weeks to months of therapy, /3-blockers have been documented consistently to increase EEs by 5 to 10 units (e.g., from an EF of 20% to 25% or 30%), to decrease ventricular mass, to improve the sphericity of the ventricle, and to reduce systolic and diastolic volumes (LVES V and LVEDV). These effects are often collectively called reverse remodeling, referring to the fact that they return the heart toward more normal size, shape, and function. 

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