A related commentary states that over the past few years, 4 clinical trials that examined vasodilator therapy in acute heart failure have been reported, and that collectively, the results of these 4 trials suggest that in the absence of hypertension, use of early intensive vasodilator therapy in acute heart failure due to fluid overload may not provide clinically significant benefit compared with standard therapy with loop diuretics to reverse congestion. The trials failed to demonstrate benefit in either short-term, symptomatic end points or longer-term outcomes, including cardiovascular mortality. In patients with pulmonary congestion who are normotensive, emphasis should be placed on adequate diuresis, with vasodilators reserved for patients whose clinical improvement has stalled. In lieu of intensive vasodilator therapy early in the hospitalisation, it may be more important to ensure that after adequate diuresis, patients with acute heart failure receive a maintenance regimen at discharge that includes sacubitril-valsartan, dapagliflozin, or both.