A Review of Why and How We May Use β-Blockers in Congestive Heart Failure: Conclusions
β-blocker used in most of the successful studies, newer nonspecific p-blockers such as bucindolol and carvedilol have advantages over metoprolol partly due to their peripheral vasodilatory properties. canada health and care mall
Although several studies have suggested the probability of a decrease in mortality with P-blockers even in addition to the effect of ACE inhibitors, to our knowledge, the only large study showing an improvement in mortality has been with carvedilol.
More large prospective double blind trials are needed to (1) establish the maximum dose for the selected P-blockers that would best increase survival, (2) confirm and publicize the beneficial effects on survival, and more clearly define the subset of patients who perhaps should not be given β-block-ers, eg, patients with proven extensive intercellular fibrosis.
Until carvedilol proves to be definitely able to decrease mortality in larger studies, the use of P-blockers for idiopathic or ischemic dilated cardiomyopathies should probably be restricted to patients who are refractory to all the usual medical management recommendations.
Beta blockade may be beneficial for most patients with CHF whether due to ischemic or idiopathic DCM, although they are more effective if the CHF is idiopathic.
β-Blockers are additive to ACE inhibitors in their effects on CHF.
β-Blockers have been shown in most studies to increase ejection fraction, cardiac output, and exercise capacity and are sometimes capable of resolving almost all the symptoms of heart failure.
Treatment should begin with the smallest possible dose and this should be gradually increased to the maximum tolerated level. It may have to be continued for more than a month before any beneficial results are seen. If deterioration occurs in the first few weeks, an increase in diuretic may stabilize the CHF and then the β-blocker therapy may be continued with the expectation of further improvement.