Pharmacologic advances in long-term heart failure management.

Advances in the pharmacologic management of patients with heart failure during the last several decades have been mainly guided by the results of well-conducted, randomized controlled clinical trials (RCTs). As a consequence of these RCTs, we now know that angiotensin-converting enzyme inhibitors and beta blockers should be concomitantly administered to patients who tolerate these therapies with the expectation that reductions in cardiovascular deaths and hospital admissions for management of heart failure will be accomplished. New therapeutic modalities must now be proven to add incremental clinical benefits to these establish therapies. This challenge is currently being addressed with aldosterone blocking agents as well as angiotensin receptor blockers. This article discusses the major RCTs in this field and places the new trials in perspective.