Congestive heart failare is a disease in which initially compensutory changes in car-diac, vascular, and renal functions become detrimental over time. The changes are mediated by a largenamber of neurohormones and cytokines. Counter-regalutory hormones also play a role, but ave general-ly insuffwient to offset the adverse effects of the neurohormones or progression of the disease. Symp-toms of heart failure occurs in the presence of systolic dysfunction, usually documented by a decrease inejection fraction, or can present with impaired diastolic function occasionally labeled as heart failureuith preserved systolic function of the left ventricle. Heart failure and its treatment represent a medicalproblem of significant importance because of the high mortality associated with it despite the current ther-apy, which has substantial evidence of reduction in mortality and morbidity. Prevention or slowing of theprogressive deterioration in function of the heart and other organs involved through utilizing new agentsthat affect more or differentneurohormonal pathways may be beneficial and forms the focus of heartfailure research and drug development. However, the multiplicity of hormonal effects mandate the useof complex therapy in the management of congestive heart failure( CHF ). The new agents in addition tothe conventional therapy used in the management of heart failure are; Human B-type natriuretic peptide(in the treatment of decompensated CHF), endothelin receptor antagonists, calcium sensitizers, neutralendopeptidase ( NEP ) and vasopeptidase inhibitors, vasopressin antagonists and cytokine inhibitors.