AT1-receptor blockers offer potential advantages in the management of heart failure, since they selectively block AT1-receptor activation, independent of the source of angiotensin II, while preserving the potentially beneficial effects of AT2-receptor activation. In placebo-controlled trials, these agents have been shown to have beneficial effects on haemodynamics and clinical status. Comparative studies, including the RESOLVD Pilot Study with candesartan, have shown that AT1-receptor blockers and angiotensin-converting-enzyme (ACE) inhibitors produce comparable changes in haemodynamics, neurohormones, cardiac function, and heart-failure symptoms. The RESOLVD Pilot Study also showed that the combination of candesartan and enalapril produced a significantly greater improvement in left-ventricular ejection fraction (LVEF) than either agent alone, consistent with the finding in the CHARM-Added study that the combination of candesartan and an ACE inhibitor significantly reduced cardiovascular mortality and morbidity, compared with ACE inhibition alone. Moreover, in the RESOLVD Pilot Study, triple combination therapy with candesartan, enalapril and metoprolol controlled release resulted in significantly improved LVEF and reductions in cardiac volumes, suggesting a favourable effect on cardiac function and remodelling, compared with dual neurohormonal blockade. By contrast, no such improvements in cardiac function were seen with valsartan in patients who were also receiving an ACE inhibitor and a β-blocker in the Val-HeFT echocardiographic substudy. In conclusion, mechanistic studies suggest that AT1-receptor blockers have a valuable role in the management of heart failure.