The role of third-generation beta-blocking agents in chronic heart failure

Third-generation beta-blocking agents developed for the hypertension market are proving useful in the treatment of chronic heart failure (HF). These c ompounds share the ancillary property of vasodilation, which improves acute tolerability by unloading the failing left ventricle at a time when beta-a drenergic withdrawal produces myocardial depression. In the case of carvedi lol and bucindolol, this allows for the administration of nonselective beta blockade. Because of blockade of both beta(1) and beta(2) adrenergic recep tors as well as other properties, these compounds possess a more comprehens ive antiadrenergic profile than second-generation, beta(1)-selective compou nds. For this and potentially other reasons, third-generation beta-blocking agents have theoretical efficacy advantages that have yet to be demonstrat ed in large-scale trials. Ongoing trials with either second- or third-gener ation compounds and one trial directly comparing a compound from each class will provide the answer as to whether third-generation compounds have an a dvantage in the treatment of chronic HF.