title: Current issues regarding beta-adrenergic blockade in patients with congestive heart failure: patient selection, nonselective versus selective blockade, management of adverse effects, and indications for withdrawal of therapy.
abstract: Neurohormonal activation and chronic adrenergic overstimulation appear to play important roles in mediating the progressive pathophysiology of congestive heart failure (CHF), and the beneficial effects of beta-blockade in the management of chronic heart failure have been demonstrated by multiple clinical trials over the last decade. Nevertheless, the initiation and maintenance of beta-blocker therapy in CHF may initially precipitate a deterioration in clinical function, and numerous questions regarding the appropriate use of these agents in patients with heart failure remain. This report examines the practicalities of beta-adrenergic blockade in heart failure, focusing on patient selection, nonselective versus selective blockade, management of adverse effects, and indications for withdrawal of therapy.
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: R
authors.initials: R
authors.lastname: Moskowitz
authors.forename: M
authors.initials: M
authors.lastname: Kukin
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists; D058672:Adrenergic beta-2 Receptor Antagonists; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000139:chemically induced; D011379:Prognosis; D013375:Substance Withdrawal Syndrome; D016019:Survival Analysis
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D058672:Adrenergic beta-2 Receptor Antagonists; D000319:Adrenergic beta-Antagonists