Skip to main content

Advertisement

SpringerLink
Log in

Beta-blockers to prevent symptomatic heart failure in patients with stage A and B heart failure

  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

β-blockers have been well-studied in the treatment of the symptomatic stages of chronic heart failure. Frequently physicians treat patients with asymptomatic left ventricular (LV) dysfunction and patients with hypertension on β-blockers without clear evidence that there is value in doing so. Chronic heart failure poses an extraordinary economic burden; any effective therapy that limits the progression to symptomatic heart failure can probably reduce monetary expenditures in addition to potentially reducing morbidity and mortality. In this article, we review the available literature on using β-blockers in stage A and B heart failure to prevent progression to the symptomatic stages. The literature reveals that there is no benefit in using β-blockers to treat essential hypertension. In patients who experience LV dysfunction post-myocardial infarction, even if asymptomatic, there is improved mortality and a trend toward a reduction in progression to symptomatic heart failure. In patients with asymptomatic chronic LV dysfunction there are data that β-blockers reduce LV dimensions and improve ejection fraction. Patients with hypertension should not be given β-blockers as primary treatment. All patients with asymptomatic LV dysfunction should be treated with a β-blocker, regardless of whether they experienced myocardial infarction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Hunt SA, Baker DW, Chin MH, et al.: ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the International Society for Heart and Lung Transplantation; endorsed by the Heart Failure Society of America. Circulation 2001, 104:2996–3007.

    PubMed  CAS  Google Scholar 

  2. O’Connell JB, Bristow MR: Economic impact of heart failure in the United States: time for a different approach. J Heart Lung Transplant 1994, 13:S107–112.

    PubMed  CAS  Google Scholar 

  3. Kannel WB: Epidemiology and prevention of cardiac failure: Framingham Study insights. Eur Heart J 1987, 8(Suppl F):23–26.

    PubMed  Google Scholar 

  4. Massie BM, Shah NB: Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management. Am Heart J 1997, 133:703–712.

    Article  PubMed  CAS  Google Scholar 

  5. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 1999, 353:9–13.

  6. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999, 353:2001–2007.

  7. Colucci WS, Packer M, Bristow MR, et al.: Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure. US Carvedilol Heart Failure Study Group. Circulation 1996, 94:2800–2806.

    PubMed  CAS  Google Scholar 

  8. Packer M, Fowler MB, Roecker EB, et al.: Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. Circulation 2002, 106:2194–2199.

    Article  PubMed  Google Scholar 

  9. Cardiovascular risk and risk factors in a randomized trial of treatment based on the beta-blocker oxprenolol: the International Prospective Primary Prevention Study in Hypertension (IPPPSH). The IPPPSH Collaborative Group. J Hypertens 1985, 3:379–392.

  10. Wilhelmsen L, Berglund G, Elmfeldt D, et al.: Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY trial. J Hypertens 1987, 5:561–572.

    Article  PubMed  CAS  Google Scholar 

  11. Hansson L, Lindholm LH, Ekbom T, et al.: Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 1999, 354:1751–1756.

    Article  PubMed  CAS  Google Scholar 

  12. Hansson L, Hedner T, Lund-Johansen P, et al.: Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000, 356:359–365.

    Article  PubMed  CAS  Google Scholar 

  13. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group. BMJ 1998, 317:713–720.

  14. Hansson L, Lindholm LH, Niskanen L, et al.: Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999, 353:611–616.

    Article  PubMed  CAS  Google Scholar 

  15. Dahlof B, Sever PS, Poulter NR, et al.: Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005, 366:895–906.

    Article  PubMed  Google Scholar 

  16. Black HR, Elliott WJ, Grandits G, et al.: Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial. JAMA 2003, 289:2073–2082.

    Article  PubMed  CAS  Google Scholar 

  17. Dahlof B, Devereux RB, Kjeldsen SE, et al.: Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002, 359:995–1003.

    Article  PubMed  CAS  Google Scholar 

  18. Psaty BM, Lumley T, Furberg CD, et al.: Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA 2003, 289:2534–2544.

    Article  PubMed  CAS  Google Scholar 

  19. Vantrimpont P, Rouleau JL, Wun CC, et al.: Additive beneficial effects of beta-blockers to angiotensin-converting enzyme inhibitors in the Survival and Ventricular Enlargement (SAVE) Study. SAVE Investigators. J Am Coll Cardiol 1997, 29:229–236.

    Article  PubMed  CAS  Google Scholar 

  20. Dargie HJ: Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet 2001, 357:1385–1390.

    Article  PubMed  CAS  Google Scholar 

  21. Colucci WS, Kolias TJ, Kirkwood F, Adams KF, et al.: Remodeling is reversed by metoprolol succinate in patients with asymptomatic left ventricular systolic dysfunction: the REVERT Trial. Presented at the AHA Scientific Sessions. Dallas, TX; November 2005.

  22. A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA 1982, 247:1707–1714.

  23. Yusuf S, Peto R, Lewis J, et al.: Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985, 27:335–371.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 1111 Amsterdam Avenue, Cardiology Clark 3, New York, NY, 10025, USA

    David M. Wild MD

Authors
  1. David M. Wild MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marrick Kukin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David M. Wild MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wild, D.M., Kukin, M. Beta-blockers to prevent symptomatic heart failure in patients with stage A and B heart failure. Curr Heart Fail Rep 4, 99–102 (2007). https://doi.org/10.1007/s11897-007-0007-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-007-0007-4

Keywords

Search

Navigation