BETA-BLOCKER USE IN SYSTOLIC HEART-FAILURE AND DILATED CARDIOMYOPATHY

Statistics regarding long-term survival for patients with heart failur e are discouraging today. Converting enzyme inhibitors have produced a modest effect on mortality beta-Blockers may be the next addition to standard therapy for heart failure because they generate consistent im provements in hemodynamic factors, symptom scores, and submaximal exer cise tolerance in randomized, controlled clinical trials. They augment ejection fraction, reduce heart volume, and consistently lower neuroh ormonal activation as reflected by plasma norepinephrine levels. Trial s with carvedilol and bisoprolol suggest an effect on mortality simila r to that with converting enzyme inhibitor trials. Future studies, esp ecially the beta-blocker Evaluation Survival Trial (BEST), with mortal ity as the main end point should elucidate the degree of effect on mor tality further.