Over 20 years' experience of beta-blockade in heart failure.
The use of beta-blocker therapy in heart failure was contraindicated for many years because it was considered to block necessary sympathetic compensatory responses to reduced cardiac function. However, early studies provided promising results in terms of improved symptoms and work capacity and reduced heart size. Small-scale studies have been completed over the past 20 years but until large-scale, long-term, randomized trials were conducted, the potential of beta-blockers in heart failure was not confirmed. The results of randomized trials published to date have included over 3,000 patients and the results show improvements in left ventricular function and heart rate. Significant improvements in New York Heart Association classification were also shown. Although no conclusive effect on mortality was shown, the first Cardiac Insufficiency Bisoprolol Study (CIBIS) indicated a trend toward improved survival during long-term treatment with bisoprolol. Ongoing studies have been specifically designed to investigate the effects of beta-blockers on survival. One of these trials, CIBIS II, which was terminated early in 1998 because of a positive effect on survival, is expected to report in late summer 1998. Such trials will also examine the different mechanisms of action of beta-blockers in heart failure and the influence of causes on the effects of beta-blockade.
Zannad
F
F
Cardiology and Clinical Pharmacology, Université Henri Poincaré, Nancy, France.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects
D000319:Adrenergic beta-Antagonists