Pharmacotherapy of congestive heart failure. An evaluation of recent advances.

Vasodilator therapy represents an important step forward in the treatment of chronic left ventricular failure. Angiotensin converting enzyme (ACE) inhibitors appear to be the most versatile vasodilators, but selected direct-acting vasodilators, sympathetic inhibitors (prazosin), and possibly calcium channel antagonists (nifedipine and diltiazem) may be useful in certain situations. The bipyridine derivatives possess potent inotropic and vasodilating properties. The efficacy of intravenously administered amrinone and milrinone has been proven in the treatment of refractory left ventricular failure. Whether oral administration of milrinone or other bipyridine derivatives will prove to be safe and effective in the long-term treatment of chronic left ventricular failure remains uncertain.