beta-Blocker therapy for congestive heart failure: clinical considerations

Excessive activation of the sympathetic nervous system and local release of norepinephrine are detrimental to the failing myocardium. Blockade of the beta-adrenergic receptor system is now a potent strategy. Earlier concerns that beta-blockade would thwart compensatory mechanisms that preserve myocardial function are no longer valid in the compensated state. Over the past 2 decades, a large body of evidence has accrued indicating marked benefits in symptoms and survival as well as favorable changes in myocardial architecture with beta-blocker therapy in patients who have compensated heart failure with impaired systolic function. This article outlines the rationale for beta-blocker therapy, examines both the early and the large-scale clinical work with beta-blocker therapy for congestive heart failure, highlights additional novel aspects of beta-blocker therapy for heart failure, and outlines expert recommendations about the use of beta-blockers in patients with systolic dysfunction.