Beta-adrenoceptor blockers in chronic heart failure--a review

There are now considerable clinical trial data to support the use of beta-adrenoceptor blockers in patients with chronic heart failure due to systolic left ventricular dysfunction. Increases in ejection fraction, improved well-being as judged by both patient and physician and reduced progression of ventricular dysfunction have been demonstrated. From meta-analyses of available trial data, a mortality reduction of approximately 30% is obtained when these drugs are added to standard heart failure therapies. Furthermore, reductions in cardiovascular morbidity associated with decreased hospitalization rates suggest pharmacoeconomic benefits with these agents. This review addresses the following issues regarding beta-adrenoceptor blockers in chronic heart failure: the known adverse effects of chronic sympathetic activation in heart failure, the theoretical benefits of blockade of this neurohormonal system, the current clinical database of beta-adrenoceptor blockers in heart failure and practical issues regarding the administration of these agents to these patients.