A rationale for the use of beta-blockers as standard treatment for heart failure

Background Cardiac sympathetic activation is one of the major and earlier c hanges observed in patients with heart failure. Its relation to the severit y of the disease and its independent prognostic value show that it may dire ctly contribute to the progression of heart failure. beta-Blockers are the most effective tool to counteract the untoward effects of sympathetic activ ation on the cardiovascular system. Methods and Results We reviewed the results of the placebo-controlled, doub le-blind studies about the effects of beta-blockers in patients with heart failure. These studies have involved almost 10,000 patients to date and hav e consistently shown that the long-term administration of beta-blockers is associated with a highly significant improvement in both left ventricular F unction and prognosis of the patients with heart failure. The evidence supp orting the use of beta-blockers now equals or even surpasses that of angiot ensin-converting enzyme inhibitors; therefore pblockers should be considere d port of standard therapy. Issues that remain unclarified include the mech anisms through which beta-blockers may improve cardiac function and their t olerability and efficacy in specific groups of patients (such as those with asymptomatic left ventricular dysfunction, severe heart failure, the elder ly, or those with left ventricular diastolic dysfunction). It is not curren tly clear whether the pharmacologic differences between individual beta-blo ckers are clinically relevant. If they are, the potential for even greater benefit with certain agents exists. It is hoped that these issues will be c larified by the results of ongoing multicenter trials.