Beta-Blockers in Congestive Heart Failure: the Evolution of a New Treatment Concept - Mechanisms of Action and Clinical Implications
Journal of Clinical and Basic Cardiology 2002; 5 (3): 215-223
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Keywords: Betablocker, dekompensierte Herzinsuffizienz, Kardiologie, beta-blocker, congestive heart failure
For a long time beta-blockers were considered contraindicated for use in heart failure although some experimental and clinical data already in the 1960s and 1970s suggested a beneficial role for beta-blockers in heart failure. Observations of good tolerability of i.v. beta-blockers in acute myocardial infarction and acute heart failure encouraged us to test beta-blockers also in chronic congestive heart failure. The accumulating knowledge of harmful effects from activated neurohormones and negative long-term effects by inotropic drugs eventually rendered the concept of beta-blocker treatment in heart failure more attractive. Beta-blockers are antiischaemic, antiproliferative, antiapoptotic, attenuate inflammatory cytokine, stabilise electrically unstable myocardium and reverse ventricular remodelling. Recent multicentre trials have definitely proved that beta-blockers reduce mortality and morbidity, are well tolerated and improve quality of life. Even in a subset of severe compensated heart failure beta-blockers have been shown to be safe and to reduce mortality and hospitalisation by 35-50 % in addition to conventional heart failure treatment with diuretics, digitalis and ACE-inhibitors. All patients with stable compensated systolic heart failure should therefore be challenged with a beta-blocker. Once stabilised on the beta-blocker most primary physicians would be able to be responsible for the long-term follow-up of these patients.