Chronic beta-blocker treatment in patients with advanced heart failure - Effects on neurohormones

Background: To date, the use of beta-blockers in treating patients with chr onic heart failure gains support, this since several large clinical trials reported reduced mortality after chronic beta-blockade. Part of these benef icial effects may result from inhibition of deleterious neurohormone activa tion that accompanies progression of chronic heart failure. The present stu dy evaluates whether this neurohormone inhibition is preserved after chroni c beta-blockade. Methods: In a retrospective analysis the neurohormonal pro files of patients with moderate to severe chronic heart failure were studie d from three treatment subgroups: (1) Without beta-blockers or ACE-inhibito rs (n=15), (2) without beta-blockers, with ACE-inhibitors (n=324), (3) with beta-blockers and ACE-inhibitors (n=31). Patients were on beta-blockers fo r an average period of 3.8 years. Plasma samples were obtained under contro lled conditions. Results: Despite uneven group sizes, the groups were well matched for clinical characteristics. Plasma renin levels were significantl y lower in patients treated adjunctively with beta-blockers. Plasma aldoste rone and endothelin-I levels also tended to be lower after chronic beta-blo ckade, however, this did not reach statistical significance. Conclusions: C hronic adjunctive beta-blocker treatment shows significantly lower plasma r enin levels when compared to single ACE-inhibition. This persistent reducti on of plasma neurohormone activation may concomitantly reduce the chance of neurohormones to escape from inhibition. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.