Perspectives of I(f) inhibition by ivabradine in cardiology.

High heart rates predict cardiovascular morbidity and mortality in the healthy population, in hypertensive patients, and in those with coronary heart disease (CHD) or heart failure. I(f) channel inhibition with ivabradine is an effective approach to reduce heart rate pharmacologically, with the prospect of preventing complications. The antianginal effects of heart rate-lowering with ivabradine have been shown to be similar to those with beta-adrenoceptor antagonists (beta-blockers) in patients with CHD. The BEAUTIfUL and SHIfT trials will provide evidence on whether I(f) channel inhibition with ivabradine is able to reduce mortality and morbidity in patients with CHD with impaired left ventricular function and heart failure. Future perspectives for additional study are potential roles of ivabradine in the treatment of hypertension and atherosclerosis, and their complications. Further clinical and mechanistic studies to clarify the pathophysiological background are needed to fully define the role of heart rate reduction in the broad spectrum of cardiovascular interventions.