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Congestive heart failure is a major clinical and public health problem affecting between 2 and 3 million people in the United States. Whereas myocardial dysfunction assumes a central pathophysiologic role in the development of chronic heart failure, alterations in the peripheral vasculature and neurohormonal systems serve to modulate the heart failure state. Short-term studies of nonspecific vasodilators and angiotensin-converting enzyme inhibitors demonstrate a beneficial effect of these agents on left ventricular function, hemodynamics, exercise tolerance, and quality of life in patients with congestive heart failure and depressed left ventricular systolic function. More recently, several large-scale multicenter trials have documented improved survival in patients with heart failure who received vasodilating agents. These studies, in conjunction with hemodynamic and functional studies, argue strongly for the widespread use of vasodilator therapy, notably the angiotensin-converting enzyme inhibitors, for congestive heart failure and left ventricular systolic dysfunction.