[Comparison beta-blockers and their relevance to pharmacologic therapy of cardiovascular diseases]

beta-Blockers have regained interest in the treatment of cardiovascular diseases after a period of decreasing importance due to the introduction of other cardiovascular treatment principles. beta-blockers expose the longest list of indications in cardiovascular therapy available and present positive mortality results for the treatment of arterial hypertension, the postinfarction situation and heart failure. There are three indications for the treatment of atrial fibrillation alone: slowing of AV-conductance, sinus rhythm restoration and atrial stabilization. Among the most recent developments there is the clear establishment of evidence for their life prolonging activity in heart failure treatment which has been proven for carvedilol, bisoprolol and metoprolol in NYHA (New York Heart Association) stages 2 and 3 and so far for carvedilol only in NYHA stage 4. Differences between beta-blocking agents are clinically most relevant for the presence of an intrinsic sympathomimetic activity (ISA) which should no longer be present in clinically used compounds. The ISA of bucindolol is the most likely reason for its failure in an outcome study for heart failure treatment. Other pharmacological distinctions relate to the selectivity in the beta-adrenergic system, activity in the alpha-adrenergic system and differences in metabolism and elimination.