DESIGN OF THE BETA-BLOCKER EVALUATION SURVIVAL TRIAL (BEST)

Central to our current understanding of heart failure is the concept t hat compensatory mechanisms that maintain blood pressure and perfusion ultimately contribute to worsening of ventricular function. Studies o f the effect of angiotensin-converting enzyme inhibitors in patients w ith heart failure are consistent with this paradigm. This manuscript d escribes a 2,800-patient randomized trial that will definitively deter mine whether sympathetic nervous system antagonism with a beta blocker prolongs the life of patients with moderate to severe heart failure.