RECENT ADVANCES IN THE DRUG-TREATMENT OF HEART-FAILURE

A number of important questions surrounding the treatment of systolic congestive heart failure have been answered by randomised clinical tri als completed within the past 2 years. In particular, these studies ha ve established that high-dose angiotensin-converting enzyme (ACE) inhi bition is more beneficial than low dose therapy, and that angiotensin II receptor antagonists are an acceptable alternative in patients unab le to tolerate ACE inhibitors. Digoxin has been shown to be the only i notropic agent not associated with increased mortality, while amiodaro ne exerts a modest survival benefit in arrhythmia-prone patients. Beta -blockers appear to be beneficial for selected patients although their precise role remains to be defined by ongoing studies.