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Published on: October 3, 2019

Effects of beta-blockers on neurohormonal activation in patients with congestive heart failure

D Baran1, E M Horn, K Hryniewicz

  • 1Columbia Presbyterian Medical Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.

Drugs
|December 29, 2000
PubMed

Insights

Long-term use of beta-blockers, particularly those without partial agonist activity, can decrease neurohormonal activation in heart failure patients. Further research is needed to understand the mechanisms and clinical significance of these effects.

Area of Science:

  • Cardiology
  • Pharmacology
  • Neuroendocrinology

Background:

  • Congestive heart failure (CHF) is associated with significant neurohormonal activation.
  • Beta-adrenoceptor antagonists (beta-blockers) are a cornerstone in CHF management.
  • Numerous small trials have investigated the impact of beta-blockers on neurohormonal pathways in CHF.

Purpose of the Study:

  • To review the effects of beta-blockers on neurohormonal activation in patients with CHF.
  • To analyze the influence of beta-blocker pharmacology and patient characteristics on acute responses.
  • To evaluate long-term effects of different beta-blocker types on sympathetic nervous system, renin-angiotensin system, and endothelin-1.

Main Methods:

  • Systematic review of small clinical trials.
  • Analysis of short-term and long-term therapeutic effects.
  • Comparison of beta1-selective, nonselective, and partial agonist beta-blockers.

Main Results:

  • Short-term beta-blocker therapy shows variable acute neurohormonal responses.
  • Long-term therapy with pure beta-blockers decreases markers of sympathetic, renin-angiotensin, and endothelin-1 activation.
  • Both beta1-selective and nonselective beta-blockers demonstrate reduced neurohormonal activation, with differing effects on receptor density.

Conclusions:

  • Long-term, pure beta-blocker therapy is associated with reduced neurohormonal activation in CHF.
  • Agents with partial agonist activity may exhibit different, potentially increased, neurohormonal activation.
  • Further investigation is required to elucidate the mechanisms and clinical relevance of beta-blocker-induced changes in adrenergic function for CHF treatment.

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