Beta-blockers in heart failure

Beta-blocker therapy for heart failure has gained popularity as a result of recent growing evidence that this group of drugs can reverse or slow the progressive left ventricular dilation that characterizes heart failure. Although the mechanism of this favourable effect on remodelling remains unclear, the present evidence indicates that at least a portion of the long-term benefit of these drugs is mediated through their beta-blocking action. A direct effect on myocyte and interstitial growth may be a key factor in their ability to inhibit the remodelling process. The growing database will eventually raise the possibility that all patients with left ventricular dilation should take one of these drugs. A better understanding of differing mechanisms in individual patients would ideally provide selectivity in the therapeutic approach.