FUTURE APPROACHES TO PHARMACOLOGICAL THERAPY FOR CONGESTIVE-HEART-FAILURE - EDITORIAL REVIEW

There have been tremendous advances in our understanding of the pathop hysiology of congestive heart failure, and this has led to improvement s in its treatment. Nonetheless, the prevalence of congestive heart fa ilure and the associated mortality and morbidity continue to increase. Hence, there remains a need for additional therapeutic approaches tha t will complement current management with diuretics, angiotensin-conve rting enzyme inhibitors, other vasodilators, and digoxin. This article reviews a number of potential avenues that are currently being evalua ted or remain targets for future investigation. Given our current unde rstanding of the mechanisms of progression of left ventricular dysfunc tion, therapies that limit neurohormonal activation or interfere with its consequences and those that improve the balance between myocardial energy requirements and supply appear to be the most promising. Agent s that improve hemodynamics without altering the underlying pathophysi ology may produce short-term symptomatic improvement but have limited potential to alter the natural history of congestive heart failure. Po sitive inotropic therapies probably fall into this category, but most of these also appear to accelerate progression and increase mortality. In the long-term, specific interventions that reverse changes at the cellular and molecular level offer the greatest promise.