Jindřich Špinar, Jiří Vítovec
Chronic heart failure is called the epidemy of the 21st century and remains to have a poor prognosis even that there is a huge progress in the pharmacological and nonpharmacological treatment. The cornerstone of the treatment of the chronic systolic heart failure is a combined blockade of the renin-angiotensin-aldosteron system (RAAS) by ACE inhibitors and AII blockers and sympathetic nervous system by beta blockers. The aldosterone blocker is recommended to be added to this combined blockade. The basic approach of treatment of the diastolic heart failure is a proper control of blood pressure, heart rhythm and heart rate, mostly by the use of beta blockers. Drugs acting via RAAS are added to the beta blockers. The initial dose of all classes should be small and slowly up titrated to doses best titrated by the patient. Aldosterone blocker should remain on a small dose.