[Beta-blockers in cardiac insufficiency].

This article reviews the information derived from various large-scale multicentre studies, summarizes current concepts concerning the mechanisms of action of beta-blockers in heart failure and recalls their modalities of use in this indication. A beneficial effect of beta-blockers on survival has not yet been formally demonstrated. However, the promising results of preliminary trials and progress in the concepts concerning the mechanism of action of beta-blockers suggest that ongoing studies will eliminate any doubts concerning this favourable effect. The action of beta-blockers in heart failure has not yet been entirely elucidated. The multiple mechanisms proposed are situated at various levels, from the organ itself to the subcellular and molecular level. Recent ideas concerning reverse remodelling of the ventricle, correction of altered genetic expression and protection against apoptosis are interdependent and particularly fascinating. The practical use of beta-blockers in this indication is specific and implementation of this treatment requires compliance with several rules, the most important of which are to start treatment at very low doses and to increase the dosage only very gradually.