Though much has still to be learned about the various actions of endothelin-1 in human physiology, current evidence suggests an important role for the peptide in the pathophysiology of CHF. The development of novel and more effective therapeutic strategies for CHF is an important priority in cardiovascular medicine, and anti-endothelin drugs appear to offer promise in this regard. The impact of ACE inhibitors has been such that for a new treatment modality to be of real value in CHF, it will need to offer haemodynamic benefit over and above that already obtained with an ACE inhibitor; anti-endothelin drugs seem to have this potential [57,98]. Ongoing studies with agents which inhibit either the generation or actions of endothelin-1 will clarify its role in the pathophysiology of CHF and determine whether anti-endothelin drugs represent a further therapeutic advance in the treatment of this disease.