Polypharmacy in chronic heart failure: practical issues regarding the use of angiotensin-converting enzyme inhibitors, beta-blockers and other drugs

Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are the cornerstone for treatment of patients with chronic heart failure (CHF), and are usually combined with diuretics, with or without digoxin. With the development of new, additional treatments, the problem of polypharmacy becomes relevant, and strategies to individualize treatment are warranted. This review considers optimal drug treatment in patients with CHF, focusing on the possible problems that can occur when combining drugs. A hierarchy of drugs is suggested, starting from the assumption of a central role for early and widespread use of ACE inhibitors and beta-blockers. A model of drug therapy is proposed that is based on each patient's individual clinical and genetic considerations, which might serve to further optimize treatment.