Mechanisms involved in the hemodynamic alterations in congestive heart failure as a basis for a rational pharmacological treatment

Congestive heart failure is a complex syndrome and one of the major cardiol ogical problems of our time. It is characterized by an important neurohumor al activation to compensate for the reduction of cardiac output and blood p ressure, that worsens the prognosis with time. The aim of the treatment is focused on how to improve the quality of life and how to prolong survival. Usually, treatment, either symptomatic or directed to control the neuroendo crine compensatory changes, is necessary. The drugs currently used are angi otensin-converting enzyme inhibitors, diuretics, digoxin, and beta -adrenoc eptor agonists. In addition, new drugs, such as angiotensin II receptor ant agonists, beta -adrenoceptor antagonists, ibopamine, Ca2+ antagonists, neut ral endopeptidase inhibitors, vasopressin antagonists, Ca2+-sensitizers wit h cyclic AMP-dependent or -independent mechanisms, and endothelin antagonis ts, are also being used. (C) 2000 Elsevier Science Inc. All rights reserved .