Tolerability of beta-blockers in heart failure: reassurance needed, reassurance provided.
In contrast to widely held perceptions regarding tolerability of beta-blockers in heart failure, it is clear that initiation and uptitration is not as complex as perceived. In particular, there is no increased risk of intolerance and/or worsening of heart failure symptoms with initiation of beta-blocker therapy (at least as demonstrated by carvedilol in COPERNICUS). Furthermore, the perceived delay in beneficial effects on outcomes is perhaps challenged by the COPERNICUS study. Interestingly, all of the above observations appear to hold true in patients with advanced disease. Because of the unique history of beta-blockers in systolic heart failure, physicians have needed particular reassurance regarding the tolerability of these agents. Reassurance regarding tolerability has now been definitively provided.
Krum
Henry
H
NHMRC Centre of Clinical Research Excellence in Therapeutics, Department of Medicine, Epidemiology and Preventive Medicine, Monash University Central and Eastern Clinical School, Alfred Hospital, Melbourne, Victoria, Australia.
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008790:Metoprolol / Q000009:adverse effects / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D008790:Metoprolol