Waagstein F
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Am J Cardiol. 1997 Nov 13;80(9B):45J-49J. doi: 10.1016/s0002-9149(97)00839-4.
Despite the well-documented benefits of beta blockade in a variety of cardiovascular conditions, the value of beta blockade in congestive heart failure (CHF) is still in question. The concept of neurohormonal blockade in heart failure has, however, brought beta blockade into focus. There is experimental evidence for the value of blocking sympathetic activation in CHF, and increased sympathetic activation may be an etiologic factor for development of CHF. Clinical studies have shown that long-term beta blockade improves both systolic and diastolic function. The effects on exercise tolerance and quality of life seem to differ between beta1-selective and nonselective beta blockers in favor of the beta1-selective blockers. To date, results of all trials reveal a consistent pattern of decreased cardiovascular morbidity. In one trial of metoprolol, fewer heart transplantations were required; such a reduction may have a great impact on healthcare costs associated with heart failure. Improved long-term survival found by one study must be confirmed in additional trials: 3 such survival trials (with metoprolol, bisoprolol, and bucindolol) are now in progress.
尽管β受体阻滞剂在多种心血管疾病中的益处已有充分记录，但β受体阻滞剂在充血性心力衰竭（CHF）中的价值仍存在疑问。然而，心力衰竭中神经激素阻断的概念使β受体阻滞剂成为焦点。有实验证据表明，阻断CHF中的交感神经激活具有价值，并且交感神经激活增加可能是CHF发生发展的一个病因。临床研究表明，长期β受体阻滞剂可改善收缩和舒张功能。β1选择性和非选择性β受体阻滞剂对运动耐量和生活质量的影响似乎有所不同，β1选择性阻滞剂更具优势。迄今为止，所有试验结果都显示出心血管发病率降低的一致模式。在一项美托洛尔试验中，需要进行心脏移植的病例减少；这种减少可能会对与心力衰竭相关的医疗费用产生重大影响。一项研究发现的长期生存率提高情况必须在更多试验中得到证实：目前正在进行3项此类生存试验（使用美托洛尔、比索洛尔和布新洛尔）。
