THE TREATMENT OF HEART-FAILURE - THE ROLE OF NEUROHUMORAL ACTIVATION

Neurohumoral activation refers to increased activity of the sympatheti c nervous system, renin-angiotensin system, vasopressin and atrial nat riuretic peptide, It is now known that neurohumoral activation contrib utes to the transition from ventricular dysfunction to clinical heart failure, and is an independent predictor of poor prognosis in heart fa ilure, Although the treatment of heart failure has traditionally focus ed on drugs to improve ventricular function, there is increasing evide nce that therapeutic modulation of neurohumoral activation is a key to successful treatment of heart failure, For example, there is mounting evidence that angiotensin converting enzyme inhibitors (the unquestio ned cornerstone for treatment of heart failure), beta receptor blocker s, digitalis, and endurance exercise training exert their benefit in h eart failure in large part through neurohumoral modulation, This obser vation - discussed in this brief review - highlights the concept that compensatory neurohumoral activation to decreased cardiac function may itself contribute to the development of heart failure and its poor pr ognosis.