PDFs are generated (and therefore designed) from other programs that utilize terrific composition and layout techniques such as master pages, extremely accurate typeface/font metrics, etc. Those same tools and concepts are not part Acrobat's arsenal of tools, as one doesn't generally 'design' in Acrobat itself. The good news in all this is that you can utilize whatever program you want (and are comfortable with) to design your documents, and use all those nice bells and whistles from your source application. You would then output to PDF, and all should be good.
I hope this is useful.