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Beta-blockers in chronic heart failure: considerations for selecting an agent Kukin MLMayo Clin Proc 2002[Nov]; 77 (11): 1199-206Patients with chronic heart failure have increased sympathetic nervous system activity that contributes to deterioration of cardiovascular function over time. Long-term beta-blocker therapy prevents such deterioration through inhibition of this neurohormonal pathway. The impressive survival data collected from several large studies have made beta-blockers a component of standard therapy for New York Heart Association class II to III heart failure. Although there are differences in the pharmacological properties of the beta-blockers shown to improve morbidity and mortality in heart failure, there is little evidence to suggest that such properties constitute any major advantages in clinical outcome. Carvedilol and extended-release metoprolol succinate are 2 beta-blockers currently approved in the United States for the treatment of patients with heart failure. Both agents have shown similar risk reductions in overall and cause-specific mortality; however, no outcome data from a comparative trial are available to support the use of one agent over the other. Regardless of the agent chosen, appropriate dosing and titration of beta-blockers are essential for successful therapy.|Adrenergic beta-Antagonists/*administration & dosage/adverse effects[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Chronic Disease[MESH]|Controlled Clinical Trials as Topic[MESH]|Dose-Response Relationship, Drug[MESH]|Drug Administration Schedule[MESH]|Female[MESH]|Heart Failure/diagnosis/*drug therapy/*mortality[MESH]|Humans[MESH]|Long-Term Care[MESH]|Male[MESH]|Middle Aged[MESH]|Prognosis[MESH]|Risk Assessment[MESH]|Severity of Illness Index[MESH]|Survival Analysis[MESH]|Treatment Outcome[MESH] |
