BETA-ADRENERGIC BLOCKERS IN HEART-FAILURE - SHOULD THEY ALWAYS BE INCLUDED IN THE THERAPEUTIC STRATEGY - ARGUMENTS AGAINST

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.