Beta-blocking in heart failure patients - Balancing the evidence

Evidence for the effectiveness of beta-blockers in the management of patien ts with heart failure is now compelling with a database of over 13 000 pati ents enrolled in randomised prospective placebo-controlled clinical trials. However this therapy remains vastly underused in clinical practice. The di fferent points challenging the widespread use beta blockade agents in the r outine treatment in heart failure are presented and discussed. After a revi ew of the potential mechanism hypothesised behind the benefits of beta-bloc kers in heart failure, the controversial effects on the haemodynamics, exer cise tolerance, hospitalisation and mortality are underlined. (C) 2001 Else vier Science Ireland Ltd. All rights reserved.