Use of beta-adrenoceptor blockers in patients with congestive heart failure

Abstract

The beneficial effect of chronic beta-blockade in patients with congestive heart failure has been repeatedly shown since its introduction into treatment for this condition in 1975. Still this kind of therapy remains controversial, it is sometimes regarded as a therapeutic paradox, and its use is mainly limited to specialist centers. Various favorable effects of beta-blockers in patients with heart failure due to idiopathic dilated cardiomyopathy and ischemic heart disease have been demonstrated, the principal among them being reduction in energy requirements and ischemia, antiarrhythmogenic effect, improvement of diastolic function, protection of myocytes against catecholamine overload, centrally mediated increase in vagal tone, upregulation of beta-adrenergic receptors, and possible blockade of autoantibodies against beta 1-receptors. Although most of the studies used metoprolol, these effects may be relevant to certain other beta-blockers. Despite very solid pathophysiological and pharmacological rationales for the use of beta-blockade, a major obstacle for a general acceptance of this therapeutic concept is the striking contrast between hemodynamic changes during the acute effect and long-term treatment. When titrated carefully from very low doses and used with a true commitment to long-term treatment, beta-blockers have been shown to prevent further deterioration of heart failure and to improve hemodynamics, exercise tolerance, quality of life, and prognosis.

Changes in cardiovascular responsiveness to dopexamine and β1‐ and β2‐adrenoceptor function after the chronic treatment of β‐adrenoceptor antagonists and agonists in anaesthetized dogs

“…The influence of the baroreceptor reflex on the chronotropic responses to noradrenaline makes it difficult to interpret the effect of pretreatment along these lines. The present results are in agreement with those of Brodde et al effects may have important clinical implications for the use of P-adrenoceptor agonists and antagonists in the management of heart failure (Brodde, 1991;Panfilov, Wahlqvist & Olsson, 1995).…”

Managing Beta-blockers in Acute Heart Failure: When to Start and When to Stop?

“…Historically, β-blockers are well-known agents with negative inotropic effects that rendered their introduction to the therapeutic armamentarium of HF relatively later than other agents even though they were discovered earlier [5]. Upon better understanding the pathophysiology of HF, β-blockers were introduced with slow and cautious steps into trial areas [6].…”

Current and newer approaches in the drug treatment of congestive heart failure

“…In spite of this, the aforementioned beneficial effect of betablockers might be based on an interesting mechanism connected with neuroendocrine compensatory mechanisms and their sequelae for cardiac betaadrenoceptors. Accordingly, the potentially favorable effect of beta-blockers in CHF patients might be explained by the following mechanisms [35,36]:…”