β-Blockers in congestive heart failure

Activation of the sympathetic nervous system (SNS) and renin-angi-otensin system (RAS) plays a pivotal role in the pathophysiology and progression of the disease in chronic heart failure (CHF). Blocking the activation of the RAS with angiotensin converting enzyme inhibitors not only improves symptoms but also prolongs life in symptomatic CHF. Does a similar analogy hold true for the use of ß-blockers in CHF? Evidence from a number of small trials and several recent large prospective trials show that b-blockers may improve ventricular function and symptoms in CHF. In a combination of trials investigating the use of carvedilol (an a₁and ß-blocker) in congestive heart failure a mortality benefit appears to be evident. There are still a number of key questions that remain unanswered regarding the tolerability, patient type and stage of CHF in which ß-blockers should be advocated. Several large-scale trials are in progress to answer some of these questions and also to add further information regarding its efficacy and impact on survival. (JUMMEC 1999; 1:26-33)