Bucindolol hydrochloride is a phenoxypropanolamine with potent nonselective beta antagonist and mild vasodilatory properties. In humans with congestive heart failure, it is extremely well tolerated and produces improvements in left ventricular systolic (ejection fraction, systolic elastance, cardiac index, and stroke work) and diastolic (isovolumic relaxation) performance while reducing pulmonary artery pressures and heart rate. These improvements occur without an increase in myocardial oxygen extraction or oxygen consumption. In addition, functional class improves with this agent although exercise tolerance and maximal oxygen consumption (VO2max) does not change, an effect that is not unexpected with a beta-adrenergic antagonist. Bucindolol produces a decrease in plasma renin activity and plasma norepinephrine, effects that may be beneficial for the long-term treatment of congestive heart failure. However, these effects are most marked in patients with idiopathic dilated cardiomyopathy compared with patients with ischemic heart disease. This agent holds great promise for the treatment of heart failure patients.