[Medical management of chronic systolic heart failure]

Medical management of systolic heart failure is standardized and based on international guidelines. They promote the use of combination therapy based on neurohormonal blockade targeting both the renin-angiotensin system (with ACE inhibitors or ARB) and sympathetic nervous system (i.e., beta blockers). Drugs have to be titrated at the maximum tolerated level. In symptomatic patients, loop diuretics remain the treatment of choice with dosage adaptation according to symptoms and fluid management. Aldosterone antagonists are indicated in patients with severe heart failure (i.e., NYHA class 3 or 4) and creatinine clearance above 30 ml/min. Their combination with RAS blockers warrants strict biological follow up.