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A Review of Why and How We May Use β-Blockers in Congestive Heart Failure

Jules Constant
Author and Funding Information

From the State University of New York at Buffalo


1998 by the American College of Chest Physicians


Chest. 1998;113(3):800-808. doi:10.1378/chest.113.3.800
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Published online

Abstract

The history of the use of β-blockers for congestive heart failure, beginning with the innovative seminal study by the Swedish group in 1975 to studies in 1995, is reviewed and shows that almost all trials favored the use of β-blockers. They tended to demonstrate an increase in ejection fraction, a decrease in left ventricular mass, and in some studies, even a decrease in mortality. Even after the introduction of angiotensin-converting enzyme inhibitors, additional improvement in function and mortality was observed. Patients with nonischemic dilated cardiomyopathy derived more benefit from β-blockers than did patients with ischemic cardiomyopathy. Least likely to benefit were patients treated for <2 months, patients with alcoholic cardiomyopathy, and those with marked intercellular fibrosis. Although the starting dose of metoprolol, the most common β-blocker used, may have to be as low as 2.5 mg/d, mortality analysis failed to show a decrease in sudden death unless the dose was raised to about 300 mg/d, a dose at which β-selectivity is generally not expected to be present. The non-β-specific bucindolol or carvedilol may ultimately be preferred to metoprolol because they are better tolerated initially due to a slight vasodilatation effect. Initial studies with carvedilol showed remarkable promise in reducing mortality. However, these agents cannot yet be said to have been studied adequately.


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