Beta blockers for congestive heart failure

The prognosis remains poor for many patients with congestive heart failure, despite maximal medical treatment with ACE inhibitor, diuretics and digitalis. In heart failure, activation of sympathetic nervous system has been described as one of the most important pathophysiologic abnormalities in patients with congestive heart failure and as one of the most important mechanisms that may be responsible for progression of heart failure. The use of beta blockers which may inhibit sympathetic activity, might reduce the risk of disease progression in heart failure, improve symptoms and increase survival. Several large clinical trials with metoprolol, carvedilol and bisoprolol have shown that long term use of these agents can improve left ventricular function and symptoms of CHF, it may also reduce hospital readmission and decrease mortality. Current guidelines recommend the use of beta blocker in mild, moderate and severe CHF, in the absence of contraindications or tolerance in combination with ACE inhibitor and diuretics. Beta blocker should be initiated in patients after maximal medical therapy with diuretics, ACE inhibitor and digitalis and patients already stabilized and in compensated conditions. Beta blocker should be started in low doses and require slow titration over weeks or months before patients can attain maintenance doses.