β-blocker therapy of heart failure: an update

Abstract

The beneficial effects of β-blocker therapy in patients with heart failure have been consistently shown by multi-center randomised trials. These agents are effective and also relatively well tolerated in the elderly and in patients with diabetes and advanced heart failure – traditionally considered as relative contraindications to their administration. However, the use of β-blockers in clinical practice remains low. The difficulties in their initiation and up-titration may be overcome by patient and physician education, as well as by their initiation during hospitalisation and/or the involvement of non-physician providers (i.e., a nurse facilitator). Forthcoming advances in the pharmacokinetic and pharmacodynamic characteristics of some β-blockers, and testing of novel methods for patient and drug selection may be based on genetic testing, and may allow further improvement of β-blocker therapy in the next future.

Keywords::

• β-blockers
• bisoprolol
• carvedilol
• heart failure
• metoprolol
• nebivolol