Cardiac muscle hypertrophies in response to increased blood pressure or metabolic stress. But rather than being beneficial, as with exercise or pregnancy, the sort of growth that occurs is harmful to cardiac performance and viability, and may lead to heart failure. In fact, pathological hypertrophy is a strong predictor of morbidity and mortality. Preventing or reversing adverse cardiac remodeling is proven to be beneficial. While beta blockers and ACE inhibitors are effective in this regard, there is a clear need for additional therapeutic approaches. In their comprehensive review that appears in this issue (Targeting Cardiac Hypertrophy - Towards Causal Heart Failure Therapy), Dr. Heinzel and colleagues discuss novel drug approaches for tackling cardiac hypertrophy and heart failure in the context of the various signaling pathways that feed into maladaptive growth. These include third generation aldosterone antagonists, aldosterone synthesis inhibitors, ACE2 and Mas receptor agonists, and biased angiotensin II AT1 receptor agonists. Exploiting endogenous cGMP-protective signaling is another strategy ripe for exploration that has already shown promise with a combination vasopeptidase neprilysin inhibitor and AT1 receptor blocker (ARNi). Lastly, Dr. Heinzel and colleagues discuss promising novel molecular genetic approaches to revitalize cardiac muscle.
-George Booz, JCVP Associate Editor
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