Beta-blocker therapy of heart failure: an update.
The beneficial effects of beta-blocker therapy in patients with heart failure have been consistently shown by multi-center randomised trials. These agents are effective and also relatively well tolerated in the elderly and in patients with diabetes and advanced heart failure--traditionally considered as relative contraindications to their administration. However, the use of beta-blockers in clinical practice remains low. The difficulties in their initiation and up-titration may be overcome by patient and physician education, as well as by their initiation during hospitalisation and/or the involvement of non-physician providers (i.e., a nurse facilitator). Forthcoming advances in the pharmacokinetic and pharmacodynamic characteristics of some beta-blockers, and testing of novel methods for patient and drug selection may be based on genetic testing, and may allow further improvement of beta-blocker therapy in the next future.
Metra
Marco
M
University of Brescia c/o Cardiologia, Section of Cardiovascular Diseases, Department of Experimental and Applied Medicine, Spedali Civili, P.zza Spedali Civili 125123 Brescia, Italy. metramarco@libero.it
Nodari
Savina
S
Bordonali
Tania
T
Milani
Patrizia
P
Fracassi
Francesco
F
Dei Cas
Livio
L
D000319:Adrenergic beta-Antagonists / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D006333:Heart Failure / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D006801:Humans
D000319:Adrenergic beta-Antagonists