Jo. Aso et al., BETA-ADRENERGIC BLOCKERS IN HEART-FAILURE - SHOULD THEY ALWAYS BE INCLUDED IN THE THERAPEUTIC STRATEGY - ARGUMENTS AGAINST, Revista espanola de cardiologia, 50(5), 1997, pp. 304-307
The evidence supporting the use of beta-adrenergic blockers in the tre
atment of heart failure secondary to systolic dysfunction is reviewed.
Up to date, seven controlled trials of carvedilol in patients with he
art failure have been published. It has been concluded that the use of
the non-selective, third generation beta-adrenergic blockers, with al
pha-adrenergic (vasodilator) and antioxidant properties, carvedilol, i
s only justified in patients with mild or moderate heart failure witho
ut; contraindications to beta-adrenergic blockers. There are not data
to support the use of carvedilol in patients with severe or unstable h
eart failure. It seems logical to wait for the results of the ongoing
trials (BEST Trial, CIBIS II Trial, COMET Trial, and MERIT Trial) to m
ore precisely define the role that beta-adrenergic blockers should pla
y in the treatment of patients with heart failure. The information pre
sently available suggests that carvedilol should be considered a thera
peutic agent for the prevention of progressive clinical heart failure
rather than for the treatment of refractory heart failure.