Treatment of congestive heart failure in the elderly: emphasis on renal functional changes and impact of therapy

Congestive heart failure (CHF) is a syndrome in which the kidney plays a fundamental role, as sodium retention is a hallmark of the syndrome. An additional hallmark of CHF is that it affects the elderly disproportionately. This high incidence of CHF in the elderly is complicated by age-related alterations in renal hemodynamics and tubular function. In view of these age-related renal alterations, pharmacologic therapy for CHF in the elderly needs to be closely monitored. In addition, recent understanding of neurohumoral mechanisms of CHF has led to new therapeutic options for the treatment of CHF, which are reviewed here.