NOVEL DRUGS AND CURRENT THERAPEUTIC APPROACHES IN THE TREATMENT OF HEART-FAILURE

Treatment of heart failure attempts to reduce symptoms, increase funct ional capacity and prolong survival, Optimal therapy usually requires a combination of several drugs, At present, ACE inhibitors are the dru gs of first choice, but must be combined with diuretics in symptomatic patients. Digitalis glycosides are still an important supplement to d iuretics and ACE inhibitors. Specific angiotensin receptor antagonists such as losartan have an effect comparable with that of ACE inhibitor s and may possess certain advantages because of their direct effect at the receptor level. Extensive research has been conducted in the trea tment of heart failure. Newer direct acting vasodilators such as flose quinan and epoprostenol have demonstrated improved exercise tolerance but have an adverse effect on mortality. Positive inotropic agents con sisting of a heterogeneous group of drugs have been evaluated. Althoug h novel agents such as xamoterol, milrinone, pimobendan and vesnarinon e have demonstrated improved haemodynamics and improved symptoms, they are not advisable at present due to increased mortality related to tr eatment or a high incidence of adverse events.