Beta-adrenergic blockers in heart failure: review of mechanisms of action and clinical outcomes.
Better understanding of the pathophysiology of heart failure has shifted the treatment of heart failure away from enhancing myocardial contractility to a new paradigm that targets the root cause of disease progression by blocking the adverse effects of excessive neurohormonal activation. Beta-adrenergic receptor-blockers have emerged as a cornerstone in the management of symptomatic heart failure. This article reviews the normal functioning of the beta-adrenergic pathway, the consequences of hyperadrenergism on this crucial signaling pathway, and the mechanisms by which chronic beta-blocker therapy reverses these abnormalities. The clinical evidence from controlled trials of the efficacy of beta-blockers in treating heart failure is summarized. Finally, the concomitant use of beta-blockers and positive inotropic agents in advanced heart failure is discussed.
Satwani
Shiyam
S
Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA.
Dec
G William
GW
Narula
Jagat
J
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D032342:Muscle Cells / Q000502:physiology; D009200:Myocardial Contraction / Q000187:drug effects; D016032:Randomized Controlled Trials as Topic; D015398:Signal Transduction; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists