[Beta-blockers in chronic heart failure]

Chronic heart failure (CHF) constitutes a significant clinical issue due to its increasing prevalence in general population and still fatal prognosis. During last twenty years the significance of beta-blockers in the treatment of CHF has changed. It resulted from the hypothesis from 1975 that in the course of CHF it comes to the activation of sympathetic system and renin-angiotensin-aldosterone system. Authors presented the actual views on CHF pathogenesis, mechanisms of favourable action of beta-blockers in CHF and the data from clinical trials on effectiveness of beta-blockers in different stages of CHF (among the others in elderly patients and in comparison with other treatment). Nevertheless, there are still several questions related to beta-blockers treatment in patients with CHF waiting to be resolved. Although the number of patients with CHF treated with beta-blockers is still increasing, the usefulness of conclusions resulting from clinical trials--as it has been shown in IMPROVEMENT-HF--is still insufficient. In contrast, following the recommendations of ESC, AHA and the Section of Heart Failure of Polish Cardiology Association both beta-blockers and ACE inhibitors constitute two main groups of medications that should be undoubtedly used in patients with CHF.