Last update:
07-Jul-2004

Until recently β-blockers were contraindicated for the treatment of chronic heart failure and their administration was avoided in heart failure patients. The use of β-blockers in heart failure is justified by the fact that increased activation of the adrenergic system in heart failure results in adverse biological signals to the cardiac myocytes. While the effects of β-blockers on exercise capacity and quality of life in heart failure patients are still controversial, clinical trials clearly show improvement in left ventricular function and reduction in its size, as well as fewer hospitalizations from aggravated heart failure. Four adequately powered β-blocker trials, US Carvedilol, CIBIS II, MERIT-HF and COPERNICUS, showed that treatment with β-blockers significantly reduced total and sudden death mortality in heart failure patients. Now, β-blockers are recommended for patients with mild to severe chronic heart failure (NYHA functional class II–IV) and with depressed left ventricular function. Uncertainties still persist about the use of β-blockers in patients with NYHA functional class I and in some specific patient groups with heart failure. Treatment with β-blockers should be started at a very low initial dosage and then titrated up to the maximal tolerated dosage. Today, despite impressive results in terms of morbidity and mortality, β-blocker use in heart failure patients is limited, with only a minority of them benefitting.

Key words: Adrenergic system, β-blockers, Chronic heart failure, Reverse remodeling.