The addition of angiotensin receptor blockers to angiotensin-converting enzyme inhibitors--what has time told us?

The neurohormonal hypothesis for the pathogenesis of heart failure found an early champion in the angiotensin-converting enzyme (ACE) inhibitors. More recently, the beta-blockers and aldosterone receptor antagonists have provided significant support by demonstrating marked additive clinical benefit. Within this context, angiotensin receptor blockers (ARBs) were specifically designed to antagonize one of the most potent contributors to the development and progression of heart failure, angiotensin. This review discusses the recent evidence for the addition of ARBs to standard therapy with ACE inhibitors and suggests how this evidence may be used to care for patients.