Practical guidelines to optimize effectiveness of beta-blockade in patients postinfarction and in those with chronic heart failure.
Antiadrenergic therapy reduces the risks of death and major morbidity in patients postinfarction and in those with chronic heart failure. Despite the common perception, these benefits are not attributable to a class effect, and clinical trials reveal evidence of specific agents that provide clinical advantages. To optimize patient outcome in the postinfarction setting, propranolol or timolol should be used in the setting of preserved ventricular function, and carvedilol should be used in patients with impaired ventricular function, with or without clinical evidence of heart failure. Patients with chronic heart failure are at lower risk of death when treated with carvedilol, which is also associated with a lower incidence of developing diabetes mellitus-related adverse events. This article reviews the scientific evidence for the hierarchy of antiadrenergic agents and addresses practical issues associated with initiation of therapy and long-term management.
Sackner-Bernstein
Jonathan D
JD
Clinical Scholars Program, Division of Cardiology, North Shore University Hospital, Manhasset, New York 11030, USA. jonathansb@yahoo.com
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists