Research into therapeutic strategies to manipulate the neuroendocrine responses activated in heart failure has been intense. Alongside classic drugs with proven efficacy such as ß-adrenergic blockers and angiotensin-converting enzyme inhibitors, alternative strategies are being developed to block the sympathetic nervous system, the reninangiotensin system, endothelin, as well as numerous cytokines and enzyme systems known to play a major role in the pathogenesis of heart failure. These include angiotensin II–receptor blockers (whose role is still controversial), monoclonal antibodies to block tumor necrosis factor–
, endothelin-receptor blockers, matrix metalloproteinase blockers, neutral endopeptidase blockers, and aldosterone blockers. Most of these agents are currently undergoing clinical trials, the results of which are eagerly awaited...