Controversies in the pharmacologic therapy of patients with heart failure

Current evidence suggests that all patients with chronic heart failure (HF) and systolic left ventricular dysfunction (SLVD) should be treated with an angiotensin converting enzyme –inhibitor ( ACE-I) and a beta adrenergic blocking agent (  BB) to reduce cardiovascular (CV) mortality and hospitalization for HF , unless contraindicated or not tolerated  (1). Most patients with chronic HF and SLVD will also require a diuretic. However , the role of diuretics , especially non potassium sparing diurectics (NPSDs) is controversial since a retrospective analysis of the studies of left ventricular dysfunction (SOLVD) has suggested that the use of NPSDs is associated with an increased risk of death due to progressive HF and sudden card

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