USE OF BETA-ADRENOCEPTOR BLOCKERS IN PATIENTS WITH CONGESTIVE-HEART-FAILURE

The beneficial effect of chronic beta-blockade in patients with conges tive heart failure has been repeatedly shown since its introduction in to treatment for this condition in 1975. Still this kind of therapy re mains controversial, it is sometimes regarded as a therapeutic paradox , and its use is mainly limited to specialist centers. Various favorab le effects of beta-blockers in patients with heart failure due to idio pathic dilated cardiomyopathy and ischemic heart disease have been dem onstrated, the principal among them being reduction in energy requirem ents and ischemia, antiarrhythmogenic effect, improvement of diastolic function, protection of myocytes against catecholamine overload, cent rally mediated increase in vagal tone, upregulation of beta-adrenergic receptors, and possible blockade of autoantibodies against beta(1)-re ceptors. Although most of the studies used metoprolol, these effects m ay be relevant to certain other beta-blockers. Despite very solid path ophysiological and pharmacological rationales for the use of beta-bloc kade, a major obstacle for a general acceptance of this therapeutic co ncept is the striking contrast between hemodynamic changes during the acute effect and long-term treatment. When titrated carefully from ver y low doses and used with a true commitment to long-term treatment, be ta-blockers have been shown to prevent further deterioration of heart failure and to improve hemodynamics, exercise tolerance, quality of li fe, and prognosis.