循環器ジャーナル66巻1号

2018年01月発行

特集 循環器診療　薬のギモン—エキスパートに学ぶ薬物治療のテクニック Ⅰ．心不全診療でのギモン

HFrEFの心筋保護薬．ACE阻害薬からかβ遮断薬からか？いつ始めて何をどれだけの量，使ったらいいの？

著者： 木田圭亮¹ 鈴木規雄¹

所属機関： ¹聖マリアンナ医科大学循環器内科

ページ範囲：P.20 - P.28

Point
・HFrEFの心筋保護薬，ACE阻害薬とβ遮断薬，どちらから始めてもよい，2剤とも導入しよう．
・導入は少量から，副作用，うっ血と低心拍出に注意して，可能な限り増量を試みよう．
・患者と家族へ，薬が増えることは悪いことではありません，長生きのためと伝えよう．

参考文献

1) Ammar KA, Jacobsen SJ, Mahoney DW, et al:Prevalence and prognostic significance of heart failure stages:application of the American College of Cardiology/American Heart Association heart failure staging criteria in the community. Circulation 115:1563-1570, 2007

2) Ponikowski P, Voors AA, Anker SD, et al:2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 37:2129-2200, 2016

3) Lupón J, Díez-López C, de Antonio M, et al:Recovered heart failure with reduced ejection fraction and outcomes:a prospective study. Eur J Heart Fail, 2017 ［Epub ahead of print］

4) The SOLVD Investigators:Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 327:685-691, 1992

5) The SOLVD Investigators:Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 325:293-302, 1991

6) The CONSENSUS Trial Study Group:Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study（CONSENSUS）. N Engl J Med 316:1429-1435, 1987

7) Hamilton RJ, Carter WA, Gallagher EJ:Rapid improvement of acute pulmonary edema with sublingual captopril. Acta Emerg Med 3:205-212, 1996

8) Gartis WA, O'Connor CM, Gallup DS, et al:Predischarge initiation of carvedilol in patients hospitalized for decompensated heart failure. J Am Coll Cardiol 43:1534-1541, 2004

9) Packer M, Poole-Wilson PA, Armstrong PW, et al:Comparative effects of low and high doses of the angiotensin converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group. Circulation 100:2312-2318, 1999

10) Shinohara Y, Origasa H:Post-stroke pneumonia prevention by angiotensin-converting enzyme inhibitors:results of a metaanalysis of five studies in Asians. Adv Ther 29:900-912, 2012

11) Dargie HJ:Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction:the CAPRICORN randomised trial. Lancet 357:1385-1390, 2001

12) Packer M, Bristow MR, Cohn JN, et al:The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Eng J Med 334:1349-1355, 1996

13) The Cardiac Insufficiency Bisoprolol Study Ⅱ（CIBIS-Ⅱ):a randomised trial. Lancet 353:9-13, 1999

14) Packer M, Coats AJ, Fowler MB, et al:Effect of carvedilol on survival in severe chronic heart failure. N Eng J Med 344:1651-1658, 2001

15) Willenheimer R, van Veldhuisen DJ, Silke B, et al:Effect on survival and hospitalization of initiating treatment for chronic heart failure with bisoprolol followed by enalapril, as compared with the opposite sequence:results of the randomized Cardiac Insufficiency Bisoprolol Study（CIBIS）Ⅲ. Circulation 112:2426-2435, 2005

16) Ouwerkerk W, Voors AA, Anker SD, et al:Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure:a prospective European study. Eur Heart J, 2017［Epub ahead of print］

17) McMurray JJ, Packer M, Desai AS, et al:Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371:993-1004, 2014

18) Ponikowski P, Voors AA, Anker SD, et al:2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology（ESC）Developed with the special contribution of the Heart Failure Association（HFA）of the ESC. Eur Heart J 37:2129-2200, 2016

19) Yancy CW, Jessup M, Bozkurt B, et al:2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation 136:e137-e161, 2017

20) Swedberg K, Komajda M, Böhm M, et al:Ivabradine and outcomes in chronic heart failure（SHIFT):a randomized placebo-controlled study. Lancet 376:875-885, 2010