Congestive heart failure: how to evaluate efficacy of treatment

Vasodilators are widely used in the therapy of congestive heart failure. Different mechanisms responsible for a failure of vasodilator therapy are discussed. Tolerance and/or diminished reabsorption or a less than optimal choice of the drug may be responsible for the lack of acute response. In addition, counter-regulation, mainly by the sympathetic nervous system, may decrease the drug effect. Furthermore, the initial beneficial effect of each vasodilator can be diminished with long-term therapy. Based on a clinical assessment and on invasive and noninvasive techniques a proposal is made as to how to treat an individual patient efficaciously.