Are angiotensin-converting enzyme inhibitors and beta-blockers making an impact on the epidemiology of heart failure?

With the advent of the 21st century, heart failure has emerged as a major component of the massive public health problem of cardiovascular disease. Currently over 5 million Americans suffer from the syndrome of heart failure with significant direct treatment costs estimated to be in excess of $22 billion per year. Unfortunately, assuming present demographic and medical trends continue, these bleak statistics are expected to worsen substantially over the next two decades. Epidemiologic studies have furthered our mechanistic understanding of heart failure pathophysiology by demonstrating that many patients with this syndrome have preserved systolic function by standard indices. In a positive turn, major advances have occurred in the treatment of heart failure based on the development of clinically effective pharmacologic antagonists of the renin-angiotensin-aldosterone and sympathetic nervous systems. These agents are capable of substantially reducing the morbidity and mortality associated with heart failure. However, the importance of enhanced physician and public awareness of heart failure remains critical in the future.