Aggressive management of new-onset congestive heart failure

Therapeutic options for the management of congestive heart failure (CHF) have evolved substantially over the past 15 years. Diuretics and digitalis preparations were once the sole therapies for CHF, but angiotensin-converting enzyme (ACE) inhibitors and vasodilators have now become the cornerstones of management. These agents are used concomitantly with digitalis preparations and loop diuretics, based on abundant clinical trial data. The optimal doses of ACE inhibitors are still controversial, however. Despite the wide publication of studies showing the benefit of ACE inhibitors, the doses used in clinical practice are often substantially lower than those employed in the randomized trials, which, in turn, may be lower than optimal doses.