beta-adrenergic blocking agents in heart failure - Benefits of vasodilating and nonvasodilating agents according to patients' characteristics: A meta-analyis of clinical trials

Background: In patients with heart failure, beta-adrenergic blocking agents reduce overall and cardiovascular mortality. This meta-analysis aimed at c larifying their effect on sudden death, the magnitude of their benefit acco rding to the cause of heart failure, and whether there is any difference be tween vasodilating and nonvasodilating agents. Methods: Randomized, clinical trials were included if they evaluated a beta -adrenergic blocking agent without intrinsic sympathomimetic activity, incl uded a control group receiving placebo or standard treatment, evaluated mor tality on an intention-to-treat basis, and lasted at least 8 weeks. Results: Twenty-one trials with 5849 patients (3130 receiving beta-blockers ] were included. Median length of treatment was 6 months. Most patients had mild or moderate heart failure and were treated with angiotensin-convertin g enzyme inhibitors, diuretics, and digitalis. The beta-blockers significan tly reduced overall mortality, cardiovascular mortality, and mortality due to pump failure and sudden death by 34% to 39%. The decrease in overall mor tality in patients with ischemic heart disease (IHD) (30%) was no different from that among patients with non-IHD (26%) (P =.08). The reduction in ove rall mortality was greater with vasodilating than with non-vasodilating age nts (45% vs 27%; P =.007), particularly in patients without II-ID (62%), co mpared with those with IHD (22%; P=.03). Conclusions: In patients with heart failure, beta-blockers reduce total and cardiovascular mortality at the expense of a decrease in mortality due to pump failure and sudden death. The magnitude of the benefit is similar in p atients with IHD and in those with non-IHD. Vasodilating beta-blockers have a greater effect on overall mortality than nonvasodilating agents, particu larly in patients with non-IHD.