Angiotensin receptor blockers and heart failure: still CHARMing after VALIANT?

Abstract
The effects of ACE-inhibitors have been documented extensively during the last 15 years. They offer wide benefits to patients with cardiovascular disease. Their effects are most prominent in patients with chronic activation of the renin–angiotensin–aldosterone system (RAAS) as are those of aldosterone receptor blockade. However, adverse effects are not uncommon. Antagonism of the actions of both angiotensin II and aldosterone can lead to deterioration in renal function. Notably, ACE-inhibitors also cause cough. Alternative approaches to inhibition of the RAAS are therefore important, particularly for patients who are intolerant of an ACE-inhibitor.

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