LONG-TERM THERAPY OF PATIENTS WITH HEART-FAILURE - DRUG-THERAPY - FROM TRIAL RESULTS TO CLINICAL-PRACTICE

Heart failure (HF) represents a major problem in Western countries due to its high prevalence, frequent need for hospitalization and extreme ly severe prognosis. There have been remarkable advances in long-term drug therapy. During the last decade, the use of vasodilatators, in pa rticular of angiotensin-converting enzyme (ACE)-inhibitors, has been a dded to the traditional therapy based on diuretics and digitalis. Ther e have been several controlled clinical trials demonstrating the long- term benefits of these drugs for survival. ACE-inhibitors have reduced the risk of mortality in HF, not only by their systemic vasodilatator action but also by their positive effects on ventricular remodelling. In fact, their use has led to a reduction in the incidence of sudden death, and progression of pump dysfunction. A reduction in the inciden ce of coronary events was also observed. ACE-inhibitors, in combinatio n with diuretics and digitalis, have been rightfully introduced into l ong-term therapy of HF. At present, other pharmacological options, lik e flosequinan, some beta-blockers, and some calcium antagonists such a s felodipine and amlodipine, hold promise, but further controlled tria ls are required before they can be introduced into the therapeutic rep ertoire of HF management.