[Beta-blockers and heart failure]

Several studies have suggested that beta-blockade could provide functional benefit in heart failure, suggesting a deleterious role for the compensatory sympathetic stimulation. Beta-blockade induced benefit could result from either antagonism of any myocardial beta-adrenergic stimulation or on the opposite a paradoxical cardiac beta-adrenergic responsiveness secondary to beta-adrenergic receptor up-regulation. Two recently completed large scale multicentric placebo controlled studies, the MDC trial with metoprolol and CIBIS with bisoprolol, have confirmed that beta-blockade could functionally improve patients with heart failure. The observed survival improvement in non ischemic patients was observed only in the CIBIS trial. Such a result must be confirmed with additional studies.