The paradox of beta-adrenergic blockade for the management of congestive heart failure

Abstract

Purpose: To review the current data regarding the use of beta-adrenergic blockers for the treatment of congestive heart failure.

Material and methods: Relevant studies published between 1975 and 1991 were reviewed. Key data from each study were extracted. The significance of conclusions reached by each author(s) was identified.

Results: beta-adrenergic blockade, although still considered an investigational therapy for the treatment of congestive heart failure, has been proven in several studies to improve ventricular function, including myocardial contractility and relaxation. In addition, since beta-blockade up-regulates myocardial beta-receptors, the myocardium becomes more responsive to graded doses of beta-agonists. Speculation regarding the possible mechanisms of these effects is presented. In addition, since beta-blockers have been shown to reduce neurohormonal activation, they may have a beneficial effect on survival. Although small pilot studies or subgroup analysis of larger studies suggest beta-blockade therapy improves survival in heart failure, this has yet to be proven. Large prospective trials are warranted to study this issue.

Conclusions: As current data suggest, beta-blockers improve ventricular function and reduce neurohormonal activation in heart failure. beta-blockers should be considered as adjunctive therapy in patients with congestive heart failure. In addition, future studies are warranted to better elucidate their effects on ventricular function and survival.