β-blockers in congestive heart failure

Abstract

Recent advances in the understanding of the basic mechanisms underlying congestive heart failure (CHF) have focused on the role of neurohormonal activation. Chronic adrenergic overstimulation is directly toxic to myocardial cells, impairs function, causes peripheral vasoconstriction and may induce programmed cell death via apoptosis. β-adrenergic blockade can interrupt this pathological process. Accumulating evidence now points to a clear role for β-blocking agents in the management of heart failure, reducing both the morbidity and mortality associated with CHF. This report will review the recent clinical trials supporting the use of β-blockers in CHF, briefly highlight some practical considerations in the use of these drugs in patients with CHF and discuss several areas of controversy in which further study is needed.

• adverse effects
• clinical trials
• congestive heart failure
• diastolic dysfunction
• initiation and uptitration
• myocardial MIBG imaging
• NYHA class
• oxidative stress
• second- and third-generation β-blockers