[Beta-blockers in the treatment of heart failure]

The first attempts at treating heart failure with beta-blockers were made almost 15 years ago. A few studies, some of them controlled and randomized, suggest that beta-blockers may improve the patients' comfort, their physical capabilities, their haemodynamic values or even their life expectancy. However, the results published are conflicting. The mechanism of the beneficial effects of beta of beta-blockers is controverted, the most widely accepted hypotheses being that they protect against the toxic effect of catecholamines, act as antiarrhythmics and prevent the down regulation of beta-adrenoceptors. Numerous questions concerning the exact indications of these drugs, the nature and dosage of the beta-blocker to be used, the possible combinations with other therapies and the responses to be expected remain to be answered. When available, the results of multicentre trials currently in progress will be of assistance to determine the role of beta-blockers in the overall management of heart failure.