Heart Failure pp 153-160 | Cite as

Beta-blockers in Heart Failure: Where Do We Stand Today?

  • Finn Waagstein
Conference paper


Beta-blockers, which hitherto have been considered contraindicated for treatment of congestive heart failure, have recently been accepted for symptomatic treatment. The rationale for beta-blockers has become evident thanks to the concept of neuroendocrine activation in congestive heart failure and progress in molecular biology. There are strong data indicating that beta-blockers improve myocardial metabolism and efficacy, exert antioxidant effect, and reduce apoptosis. These results could explain the improved systolic and diastolic function, well-being, and slowing-down of disease progression. Placebo-controlled trials have shown to reduce morbidity, prevent heart transplantation, and recently also to cause overall reduction in mortality. It is now time to include betablockers in our standard armamentarium for heart failure treatment.

Key words

Beta-blockers Heart failure 


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  1. 1.
    Waagstein F, Hjalmarson A, Varnauskas E, Wallentin I (1975) Effect of chronic betaadrenergic receptor blockade in congestive cardiomyopathy. Br Heart J 37: 1022–1036PubMedCrossRefGoogle Scholar
  2. 2.
    Esler M, Kaye D, Lambert G, Esler D, Jennings G (1997) Adrenergic nervous system in heart failure. Am J Cardiol 80 (11A): 7L - 14LPubMedCrossRefGoogle Scholar
  3. 3.
    Lechat P, Escolano S, Golmard JL, Lardoux H, Witchitz S. Henneman JA, Maisch B, Hetzel M, Jaillon P, Boissel JP, Mallet A (1997) Prognostic value of bisoprolol-induced hemodynamic effects in heart failure during the Cardiac Insufficiency Bisoprolol Study ( CIBIS ). Circulation 96: 2197–2105PubMedGoogle Scholar
  4. 4.
    Andersson B, Hedner T, Blomström-Lundquist C, Waagstein F (1991) Exercise hemodynamics and myocardial metabolism during long-term beta-adrenergic blockade in severe heart failure. J Am Coll Cardiol 18: 1059–1066PubMedCrossRefGoogle Scholar
  5. 5.
    Bech J, Madsen JK, Kelbaek H, Hvid-Jacobsen K, Skagen K (1996) Metoprolol abolishes exercise-induced left ventricular dysfunction in patients with silent ischemia. Am J Cardiol 78: 871–875PubMedCrossRefGoogle Scholar
  6. 6.
    Santostasi G, Fraccarollo D, Dorigo P, Egloff C, Miraglia G, Marinato PG, Vilanova C, Fasoli G, Maragno I (1988) Early reduction in plasma norepineprhine during beta-blocking therapy with metoprolol in chronic heart failure. J Cardiac Fail 4: 177–184CrossRefGoogle Scholar
  7. 7.
    Heilbrunn SM, Shah P, Bristow MR, Valantine HA, Ginsburg R, Fowler MB (1989) Increased beta-receptor density and improved hemodynamic response to catecholamine stimulation during long-term metoprolol therapy in heart failure from dilated cardiomyopathy. Circulation 79: 483–490PubMedCrossRefGoogle Scholar
  8. 8.
    Waagstein F, Caidahl K, Wallentin I, Bergh CH, Hjalmarson A (1989) Long-term beta-blockade in congestive cardiomyopathy: effects of acute and chronic metoprolol treatment followed by withdrawal and readminstration of metoprolol. Circulation 80: 551–563PubMedCrossRefGoogle Scholar
  9. 9.
    Waagstein F, Wahlquist I, Andersson B, Böhm M. Darius M, Delius R, Dietz R, Goss F, Sigmund M, Stroemblad SO, Trenkwalder P (1998) For the metoprolol in mild to moderate heart failure study group. Metoprolol prevents left ventricular dilatation and increases exercise ejection fraction to the same extent in idiopathic dilated and ischemic cardiomyopathy. Eur Heart J 19 (suppl): 307Google Scholar
  10. 10.
    Engelmeier RS, O’Connel JB, Walsh R (1985) A randomized trial of low-dose beta-blockade therapy for idiopathic dilated cardiomyopathy. Am J Cardiol 55: 471CrossRefGoogle Scholar
  11. 11.
    Waagstein F, Bristow MR, Swedberg K, Camerini F, Fowler MB, Silver MA, Gilbert EM, Johnson MR, Goss F, Hjalmarson A (1993) For the Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet 342: 1441–1446PubMedCrossRefGoogle Scholar
  12. 12.
    Fischer ML, Gottlieb SS, Plotnick GD, Greenberg NL, Patten RD, Bennet SK, Hamilton BP (1994) Beneficial effects of metoprolol in heart failure associated with coronary artery disesase: a randomized trial. J Am Coll Cardiol 23: 943–950CrossRefGoogle Scholar
  13. 13.
    Gilbert Em, Olsen SL, Remlund DG, Bristow MR (1993) Beta-adrenergic receptor regulation and left ventricular function in idiopathic dilated cardiomyopathy. Am J Cardiol 71: 23C - 29CPubMedCrossRefGoogle Scholar
  14. 14.
    Wiklund I, Waagstein F, Swedberg K, Hjalmarson A (1996) Quality of life on treatment with metoprolol in dilated cardiomyopathy: results from MDC trial. Metoprolol in Dilated Cardiomyopathy trial. Cardivasc Drugs Ther 10: 361–368Google Scholar
  15. 15.
    Hjalmarson A, Kneider M, Waagstein F (1997) The role of beta-blockers in left ventricular dysfunction and heart failure. Drugs 54: 501–510PubMedCrossRefGoogle Scholar
  16. 16.
    Jansson K, Karlberg K-E, Nylander E, Karlsson I, Nyquist O, Dahlström U (1997) More favourable haemodynamic effects from metoprolol than from captopril in patients with dilated cardiomyopathy. Eur Heart J 18: 1115–1121PubMedGoogle Scholar
  17. 17.
    Eichhorn E, Lukas AM, Wu B, Shusterman N (1998) For the US Carvedilol Heart Failure Study Group. Effect of concomitant digoxin and carvedilol therapy on mortality and morbidity. Eur Heart J 19 (suppl): 301CrossRefGoogle Scholar
  18. 18.
    Mulieri LA, Leavitt B, Hasenfuss G, Allen PD, Alpert NR (1992) Altered myocardial force frequency relation in human heart failure. Circulation 85: 1743–1750PubMedGoogle Scholar
  19. 19.
    Andersson B, Lomsky M, Waagstein F (1993) The link between acute hemodynamic adrenergic beta-blockade and long-term effects in patients with heart failure: a study of diastolic function, heart rate and myocardial metabolism following intravenous metoprolol. Eur Heart J 14: 1375–1385PubMedCrossRefGoogle Scholar
  20. 20.
    DasGupta P, Bradhurst P, Lahiri A (1991) The effects of intravenous carvedilol, a new multiple action vasodilatory beta-blocker, in congestive heartt failure. J Cardiovasc Pharmacol 18 (suppl 4): S12 - S16PubMedGoogle Scholar
  21. 21.
    The Cardiac Insufficiency Bisoprolol Study (CIBIS) CIBIS Investigators and Committees (1994) Randomized trial of beta-blockade in heart failure. Circulation 90: 1765–1773Google Scholar
  22. 22.
    Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH (1996) The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 334: 1349–1355PubMedCrossRefGoogle Scholar
  23. 23.
    Hall SA, Cigarroa CG, Marcoux L, Rissr RC, Grayburn PA, Eichhorn EJ (1995) Time course of improvement in left ventricular function, mass and geometry in patients with congestive heart failure treated with beta-adrenergic blockade. J Am Coll Cardiol 25: 1154–1161PubMedCrossRefGoogle Scholar
  24. 24.
    Herlitz J, Waagstein F, Lindquist J, Swedberg K, Hjalmarson A (1977) Effect of metoprolol on the prognosis for patients with suspected acute myocardial infarction and indirect signs of congestive heart failure (a subgroup analysis of the Goteborg Metoprolol Trial). Am J Cardiol 80 (9B): 40J - 44JCrossRefGoogle Scholar
  25. 25.
    The BEST Steering Committee (1995) Design of the Beta-Blocker Evaluation Survival Trial (BEST). Am J Cardiol 75: 1220–1223CrossRefGoogle Scholar
  26. 26.
    Goldstein S (1997) Clinical studies on beta blockers and heart failure preceeding the MERIT-HF Trial. Metoprolol CR/XL Randomized Intervention Trial in Heart Failure. Am J Cardiol 80 (9B): 50J - 53JPubMedCrossRefGoogle Scholar
  27. 27.
    Kukin J, Kalman J, Chamey RHJ, Levy DK, Buchhoklz-Varley CX, Ocampo ON, Eng C (1988) Antioxidant effect of carvedilol and metoprolol in congestive heart failure. Am Coll Cardiol 31 (suppl A): 189ACrossRefGoogle Scholar
  28. 28.
    Sabbah HN, Sharov VG, Goussev A, Shimoyama H, Goildstein S (1998) Long-term beta-blockade with metoprolol attenautes cardiocyte apoptosis in dogs with moderate heart failure. Eur Heart J 19 (suppl): 353Google Scholar
  29. 29.
    Fesmire SI, Eichhorn EJ, Kennedy HL, Marcoux LG, Lyyski DS, Sprague MK (1998) Improvement in QT-dispersion with selective vs. non-selective beta-blockade in patients with dilated cardiomyopathy. Eur Heart J 19 (suppl): 307Google Scholar
  30. 30.
    Andersson B, Caidahl K, diLenarda A, Warren SE, Goss F, Waldenstrom A, Persson S, Wallentin I, Hjalmarson A, Waagstein F (1996) Changes in early and late diastolic filling patterns induced by long-term adrenergic blockade in patients with idiopathic dilated cardiomyopathy. Circulation 94: 673–682PubMedGoogle Scholar
  31. 31.
    Jahns R, Jensen M, Jahns V, Lohse MJ, Inselman G (1998) A new role for cardioselective beta-receptor antagonists: blocking the effects of sensitizing autoantibodies in dilated cardiomyopathy that are associated with impaired left ventriuclar function. Eur Heart J 19 (suppl): 462Google Scholar
  32. 32.
    Andersson B, Hamm C, Persson S, Wikström G, Sinagra G, Hjalmarson A, Waagstein F (1994) Improved exercise hemodynamic status in dilated cardiomyopathy after beta-adrenergic blockade treatment. J Am Coll Cardiol 23 (6): 1397–1404.PubMedCrossRefGoogle Scholar
  33. 33.
    CIBIS II Trial Investigators (1999) The cardiac insufficiency bisoprolol study II: a randomised trial. Lancet 353: 9–13.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2000

Authors and Affiliations

  • Finn Waagstein
    • 1
  1. 1.Division of Cardiology, Wallenberg LaboratorySahlgrenska University Hospital/SGöteborgSweden

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