Pharmacotherapy of congestive heart failure. Currently used and experimental drugs

A survey is given of the currently used therapeutics in the treatment of chronic congestive heart failure. Symptomatic treatment is usually performed along the following lines: rest, sodium and fluid restriction to unload the decompensating heart, loop diuretics, angiotensin-converting enzyme inhibitors or other vasodilators; inotropic agents to improve the heart's mechanical performance; attempts to counteract the neuro-endocrine compensatory mechanisms, that is the activated sympathetic nervous and renin-angiotensin-aldosterone systems, as well as the rise in vasopressine levels. New insights have been obtained in the effects of cardiac glycosides, which are probably rather based on counteracting the elevated sympathetic neuronal activity than on their weak and uncertain inotropic action. Angiotensin-converting enzyme inhibitors are probably more effective than classical vasodilators owing to their additional interaction with the neuro-endocrine compensatory mechanisms. Ibopamine, a prodrug of epinine, appears to be rather a vasodilator and antagonist of the neuro-endocrine compensatory mechanisms than an inotropic agent. The most important clinical trials addressing the efficacy and adverse reactions to the various aforementioned therapeutics are discussed. New, experimental approaches in the drug treatment of chronic congestive heart failure include beta-blockers, calcium antagonists, vasopressin antagonists and inhibitors of atrial natriuretic peptide degradation.