Beta-blockers to prevent symptomatic heart failure in patients with stage A and B heart failure.

beta-blockers have been well-studied in the treatment of the symptomatic stages of chronic heart failure. Frequently physicians treat patients with asymptomatic left ventricular (LV) dysfunction and patients with hypertension on beta-blockers without clear evidence that there is value in doing so. Chronic heart failure poses an extraordinary economic burden; any effective therapy that limits the progression to symptomatic heart failure can probably reduce monetary expenditures in addition to potentially reducing morbidity and mortality. In this article, we review the available literature on using beta-blockers in stage A and B heart failure to prevent progression to the symptomatic stages. The literature reveals that there is no benefit in using beta-blockers to treat essential hypertension. In patients who experience LV dysfunction post-myocardial infarction, even if asymptomatic, there is improved mortality and a trend toward a reduction in progression to symptomatic heart failure. In patients with asymptomatic chronic LV dysfunction there are data that beta-blockers reduce LV dimensions and improve ejection fraction. Patients with hypertension should not be given beta-blockers as primary treatment. All patients with asymptomatic LV dysfunction should be treated with a beta-blocker, regardless of whether they experienced myocardial infarction.