CONSENSUS to EMPHASIS: The overwhelming evidence which makes blockade of the reninangiotensinaldosterone system the cornerstone of therapy for systolic heart failure

We will shortly celebrate the 25th anniversary of the publication of the Co-operative North Scandinavian Enalapril Survival Study ( CONSENSUS ), a clinical trial which revolutionized the treatment of heart failure and highlighted the importance of the renin–angiotensin–aldosterone system ( RAAS ) in the pathophysiology of heart failure ( Figure 1 ). In this article I will give a brief, historical overview of this exciting quarter-century of discovery related to the RAAS. My focus is on the treatment of heart failure in patients with a low left ventricular ejection fraction