The article discusses the long-term effects of adding the angiotensin-receptor blocker valsartan to standard therapy for heart failure. A randomized trial involving 5010 patients with New York Heart Association (NYHA) class II, III, or IV heart failure found that valsartan significantly reduced the combined endpoint of mortality and morbidity by 13.2% compared to placebo. This reduction was primarily due to a lower incidence of hospitalization for heart failure. Valsartan also improved NYHA class, ejection fraction, signs and symptoms of heart failure, and quality of life. However, a post hoc analysis revealed an adverse effect on mortality and morbidity in patients already receiving angiotensin-converting enzyme (ACE) inhibitors or β-blockers, raising concerns about the safety of this combination. The editor notes that the study's limitations include the lack of detailed information on serum potassium levels and the potential for confounding factors in subgroups receiving background therapy. The authors respond by addressing these concerns and emphasizing the significant benefits of valsartan in patients not already on ACE inhibitors or β-blockers.The article discusses the long-term effects of adding the angiotensin-receptor blocker valsartan to standard therapy for heart failure. A randomized trial involving 5010 patients with New York Heart Association (NYHA) class II, III, or IV heart failure found that valsartan significantly reduced the combined endpoint of mortality and morbidity by 13.2% compared to placebo. This reduction was primarily due to a lower incidence of hospitalization for heart failure. Valsartan also improved NYHA class, ejection fraction, signs and symptoms of heart failure, and quality of life. However, a post hoc analysis revealed an adverse effect on mortality and morbidity in patients already receiving angiotensin-converting enzyme (ACE) inhibitors or β-blockers, raising concerns about the safety of this combination. The editor notes that the study's limitations include the lack of detailed information on serum potassium levels and the potential for confounding factors in subgroups receiving background therapy. The authors respond by addressing these concerns and emphasizing the significant benefits of valsartan in patients not already on ACE inhibitors or β-blockers.