Treatment of heart failure with beta-blockers. Mechanisms and results.
Sympathetic activation is a significant predictor of a poor prognosis in heart failure. Excessive stimulation with norepinephrine produces apoptosis, tachycardia and arrhythmias thereby leading to progression of left ventricular dysfunction and worsening of outcome. Beta-blockers reduce morbidity and improve cardiac function. They have been shown to improve survival (MERIT-HF, CIBIS II and US-Carvedilol Trials). A careful uptitration of dosages is achievable with a low rate of side effects. The mechanism of beta-blocker effects in heart failure are cardiac protection from beta1-adrenoceptor overstimulation, antiarrhythmic effects, reduction in heart rate and positive energetic effects or a combination thereof.
Böhm
M
M
Medizinische Klinik und Poliklinik der Universität des Saarlandes, Innere Medizin III, Homburg/Saar, Germany. boehm@med-in.uni-saarland.de
Maack
C
C
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D009490:Neurosecretory Systems / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D010807:Physical Endurance / Q000187:drug effects; D016276:Ventricular Function / Q000187:drug effects; D020257:Ventricular Remodeling / Q000187:drug effects
D000319:Adrenergic beta-Antagonists