Current and newer approaches in the drug treatment of congestive heart failure

Most patients with chronic congestive heart failure (CHF) are subjected to symptomatic treatment, predominantly with drugs. Over the years, it has become clear that treatment with unloading drugs is probably more beneficial than treatment with inotropic agents. In addition, it has been widely recognized that the neuroendocrine compensatory changes associated with CHF afford an important target for drug treatment. This may also hold for some of the changes in receptor density, such as the downregulation of cardiac beta-adrenoceptors. The present and clearly changing insights into the backgrounds of drugs for the treatment of CHF are critically discussed. Apart from the changing views and appreciation of the currently used drugs (diuretics, ACE inhibitors, digoxin, beta-adrenoceptor agonists), the following new approaches are discussed: beta-blockers, angiotensin II receptor antagonists, ibopamine, calcium antagonists, inhibitors of ANP degradation, vasopressin antagonist, vesnarinone, and calcium sensitizers.