Neurohormonal antagonism in heart failure: what is the optimal strategy?

Pharmacologic management of chronic heart failure rests on appropriate volume management followed by neurohormonal antagonism. Despite the rationale for neurohormonal antagonists, their use remains low. Definitive studies establish that neurohormonal antagonists are effective across the spectrum of disease, from the early Stage A patient at risk of developing structural heart disease and symptomatic heart failure to the Stage D patient with symptoms at rest. Although many investigators and clinicians seem focused on the next new scientific breakthrough, published studies delineate strategies that will reduce death and disability for those at risk and those with symptomatic chronic heart failure. In essence, the broad use of neurohormonal antagonists, consistent with the reports of large-scale trials that have been reported, will markedly reduce the risk of disease progression and death. Overall prognosis however remains poor. We review the data from these trials to encourage clinicians to use these proven neurohormonal antagonists in optimizing therapeutic strategy.