Beta Blockers in Heart Failure

pp 218-230

Abstract

Recognition that neurohormonal activation plays a major role in the development and progression of heart failure determined that use of beta-blockers run through an extensive course going from contraindication to nowadays indication. Several controlled trials have demonstrated that these drugs improve ventricular function through a time-dependent biological effect. Beta-blockers, irrespective of etiology of the underlying cardiomyopathy and of the severity degree of illness, improve symptoms and quality of life, increase submaximal exercise tolerance and decrease hospitalizations for worsening heart failure. Furthermore, it has been confirmed in more than 16,000 patients that they lower mortality risk through a double mechanism: reduction of sudden death, presumptively by an antiarrhythmic effect, and reduction of death from worsening heart failure.

Current evidence shows long-term treatment with betablockers have a beneficial effect on pathophysiology as well as clinical status and survival of heart failure, so that everyone with heart failure due to systolic dysfunction, already treated with diuretics and ACE inhibitors clinically stable, should take beta-blockers.It is still a. challenge to understand the precise mechanisms underlying the beneficial effects of these drugs and to determine their usefulness inpatients with asymptomatic systolic dysfunction and with heart failure and preserved systolic function.