Congestive heart failure (CHF) is a growing epidemiologic and clinical problem, and is increasing in incidence, prevalence and mortality. Therefore, the optimal treatment of heart failure (HF) is important to reduce hospitalization and mortality. In the treatment of CHF, diuretics are the first-line drug treatment for patients with fluid retention and are necessary to relieve symptoms but cannot halt progression or improve the prognosis of CHF. Angiotensin-converting enzyme inhibitors, beta-adrenergic receptor antagonists and mineralocorticoid/aldosterone receptor antagonist therapy have been shown to decrease mortality and progression of CHF and should be used early in HF with reduced ejection fraction. Angiotensin receptor antagonists are recommended in patients with current or prior symptoms who are angiotensin-converting enzyme inhibitor intolerant, unless contraindicated, to reduce morbidity and mortality. However, no treatment has been shown convincingly to reduce morbidity and mortality in patients with HF with preserved ejection fraction. Adequate treatment of hypertension and myocardial ischemia is also considered to be important, as is control of the ventricular rate in HF with preserved ejection fraction. For chronic HF with reduced ejection fraction, ivabradine and angiotensin receptor-neprilysin inhibition have been tested and may be used in evidence-based medicine in the near future. This review presents the evidence base for current drug treatments and their practical implications in chronic HF.
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