Use of beta-blockers in chronic congestive heart failure.

The sympathetic nervous system and renin angiotensin agents play an important role in heart failure both as a marker of severity of disease and also as a deteriorious factor for congestive heart failure. A beta-blocker in those patients used to be contraindicated. There has been evidence that the blocking effect of alpha and beta-receptors may ameliorate symptoms and retard progression of the disease. In early studies, the usage of a beta-blocker in mild to moderate congestive heart failure could improve symptoms, increase exercise capacity, and decrease heart size. Recently large clinical randomized, double-blind, placebo-controlled trials exhibited long-term treatment of beta-blockers, in chronic heart failure could improve cardiac function, alleviate symptoms, reduce the all-cause mortality and also risk of cardiovascular hospitalization. The appropriate dose and gradual adjustment over time with patient selection will increase benefit and decrease the adverse effects. In the future, beta-blockers may be the fourth component of the standard regimen of ACE inhibitors, diuretics and digoxin in many patients with congestive heart failure.