Clinical use of beta-blockers in patients with heart failure.
Recognition of the role of the sympathetic nervous system in chronic heart failure has resulted in dramatic changes in the way heart failure is viewed, providing strong evidence for the therapeutic role for beta-adrenergic blocking agents. This treatment strategy does not provide short-term hemodynamic improvement and may even worsen symptoms initially. However, beta-blockers can be administered with good or even excellent tolerability by slowly withdrawing adrenergic support to the failing heart. Results of clinical trials have shown that long-term treatment with beta-blockers improves ventricular function and reduces mortality rates in patients with mild-to-moderate heart failure. Although the improvement in ventricular function is a beta-blocker class effect, there are distinct differences in antiadrenergic activity and tolerability among the first-, second-, and third-generation agents. These differences--as well as practical strategies for dose titration and the management of decompensation--are the focus of this article.
Eichhorn
E J
EJ
Department of Veterans Affairs Hospital, University of Texas, Southwestern Medical Center, Dallas 75216, USA.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D006333:Heart Failure / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D013997:Time Factors; D014665:Vasodilator Agents / Q000627:therapeutic use*; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy; D020257:Ventricular Remodeling / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D014665:Vasodilator Agents