Beta-blockers in heart failure: potential of carvedilol.

The excessive or inappropriate response of the neuroendocrine system to impaired cardiac performance has become a major therapeutic target in heart failure. While the benefits of ACE inhibition and vasodilation are now established, and the necessary effects of diuretic therapy accepted, there is increasing evidence that in many patients additional benefit would follow modulation of the sympathetic nervous system. Beta-adrenergic blocking drugs improve survival following myocardial infarction and have improved patients with heart failure. Drugs such as carvedilol, which combine vasodilation mediated through alpha-adrenergic blockade with beta-adrenergic blockade have an attractive profile as they unite these two pharmacological actions in a way that may benefit patients with heart failure.