Beta-blockers in heart failure: how far have we progressed?
Beta-blockers, once considered contraindicated in patients with heart failure, are now the standard of care in such patients. This change is the result of several large-scale clinical trials, including Cardiac Insufficiency Bisoprolol Study II (CIBIS-II), Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF), and the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial, that have demonstrated significant morbidity and mortality benefits of beta-blockers in patients with heart failure caused by left ventricular systolic dysfunction. beta-blockade also improves quality of life and causes regression of cardiac remodeling, a phenomenon characteristic of chronic heart failure. This article provides an overview of the history of beta-blockade in the treatment of heart failure, beginning with the early misconception that beta-blockers are detrimental to patients with heart failure. Mechanistic and early clinical trials are reviewed, along with the results from CIBIS-II, MERIT-HF, and COPERNICUS. Barriers to the use of beta-blocker therapy also are discussed.
Adams
Kirkwood F
KF
University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7075, USA. kfa@med.unc.edu
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017298:Bisoprolol / Q000627:therapeutic use; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D000075202:Contraindications; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008790:Metoprolol / Q000627:therapeutic use; D011412:Propanolamines / Q000627:therapeutic use; D013564:Sympathetic Nervous System / Q000187:drug effects; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; C024307:bucindolol; D008790:Metoprolol; D017298:Bisoprolol