[Rational therapy of heart failure].

To stop or reverse progression of congestive heart failure is so far an unreached therapeutic goal. Several prospective studies have now clearly shown that treatment with angiotensin-converting enzyme (ACE) inhibitors resulted in a clear reduction of cardiovascular and total mortality in patients with congestive heart failure. As a consequence, ACE-inhibitors are now standard therapy for congestive heart failure in addition to diuretics and glycosides. Of pathophysiologic importance is that ACE-inhibitors are potent vasodilators and counteract the neuroendocrine stimulation of the sympathetic nervous system and the renin-angiotensin-aldosterone system which both contribute to the detrimental outcome in congestive heart failure. New results of the prevention trial of the SOLVD-Study showed that in patients with reduced ejection fraction the development of congestive heart failure could be attenuated or even stopped. The questions remain of what is the optimal dose, when should treatment with ACE-inhibitors be started, and how long should it be maintained. Thus, in patients with reduced ejection fraction after myocardial infarction ACE-inhibitors are today a cornerstone for preventing progressive congestive heart failure and improving cardiovascular prognosis. Whether beta-blockers offer additional benefit in subgroups of patients with congestive heart failure remains to be determined in future trials.