Beta-blocker use in systolic heart failure and dilated cardiomyopathy.
Statistics regarding long-term survival for patients with heart failure are discouraging today. Converting enzyme inhibitors have produced a modest effect on mortality. beta-Blockers may be the next addition to standard therapy for heart failure because they generate consistent improvements in hemodynamic factors, symptom scores, and submaximal exercise tolerance in randomized, controlled clinical trials. They augment ejection fraction, reduce heart volume, and consistently lower neurohormonal activation as reflected by plasma norepinephrine levels. Trials with carvedilol and bisoprolol suggest an effect on mortality similar to that with converting enzyme inhibitor trials. Future studies, especially the beta-blocker Evaluation Survival Trial (BEST), with mortality as the main end point should elucidate the degree of effect on mortality further.
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