Medical treatment of chronic heart failure is applied in accordance with the recommendations of the Task Force Report of the European Society of Cardiology  adapted to the respective NYHA stage of the cardiac failure. Currently, it includes the use of ACE inhibitors, beta blockers, AT1 receptor antagonists, diuretics including the aldosterone antagonists, and digitalis. While a positive impact on the prognosis has been confirmed for ACE inhibitors, beta blockers and aldosterone antagonists, this is not the case for diuretics and digitalis. These substance groups are used in the treatment of chronic heart failure because of their morbidity-lowering action. The objective of more recent therapeutic concepts is to block neurohumoral achses or local maladaptation processes (e.g. endothelial antagonists, cytokine inhibition, apoptosis inhibition) activated during the heart failure, or to promote protective mechanisms (e.g. endopeptidase inhibition). Here, however, the results of ongoing or planned randomized studies have to be awaited.