Doughty R N
Department of Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand.
Heart Fail Monit. 2000;1(1):2-7.
Heart failure is an important public health problem and one for which morbidity and mortality remain high despite treatment with angiotensin converting enzyme (ACE) inhibitors. A large number of clinical trials examining the effects of beta-blockers in the treatment of heart failure have now been performed. Two large-scale clinical trials have recently confirmed significant survival benefits with these agents, with effects that are additive to those achieved with ACE inhibitor therapy. These trials have now established beta-blocker therapy as an important part of standard heart failure treatment. The clinical use of beta-blockers in patients with heart failure requires careful translation of the randomized controlled trials into everyday clinical practice. Patient selection is key to the safe use of beta-blockers. Patients who may be suitable for beta-blockade therapy include those with mild-moderate heart failure due to left ventricular systolic impairment, those who are receiving adequate dose of diuretics and ACE inhibitors and those whose clinical condition is stable at the time of initiation of the beta-blocker. Survival benefits have been demonstrated with bisoprolol, carvedilol and metoprolol. Whether different beta-blockers have important clinical differences with regard to clinical end-points is as yet uncertain. beta-Blockers should be initiated at low dose, with titration of dose over several weeks and careful clinical monitoring for potential adverse effects, such as hypotension or worsening congestion. This careful application of the clinical trials into clinical practice will allow the safe use of this effective treatment for patients with chronic heart failure.
心力衰竭是一个重要的公共卫生问题，尽管使用了血管紧张素转换酶（ACE）抑制剂进行治疗，但其发病率和死亡率仍然很高。现在已经进行了大量研究β受体阻滞剂治疗心力衰竭效果的临床试验。最近两项大规模临床试验证实了这些药物具有显著的生存获益，其效果与ACE抑制剂治疗的效果具有相加作用。这些试验现已确立β受体阻滞剂治疗是标准心力衰竭治疗的重要组成部分。在心力衰竭患者中临床使用β受体阻滞剂需要将随机对照试验的结果谨慎地转化为日常临床实践。患者选择是安全使用β受体阻滞剂的关键。可能适合β受体阻滞剂治疗的患者包括因左心室收缩功能不全导致轻至中度心力衰竭的患者、正在接受足量利尿剂和ACE抑制剂治疗的患者以及在开始使用β受体阻滞剂时临床状况稳定的患者。比索洛尔、卡维地洛和美托洛尔已证实具有生存获益。不同β受体阻滞剂在临床终点方面是否存在重要临床差异尚不确定。β受体阻滞剂应从小剂量开始使用，在数周内逐渐滴定剂量，并仔细临床监测潜在的不良反应，如低血压或充血加重。将临床试验结果谨慎地应用于临床实践将使慢性心力衰竭患者能够安全使用这种有效的治疗方法。
