β-Blocker Use for the Stages of Heart Failure

The 2005 American Heart Association/American College of Cardiology heart failure (HF) guidelines contributed to a renewed focus on "at-risk" patients and emphasized HF as a progressive disease. Patient categorization by stages focused attention on customization of therapy to achieve optimal, evidence-based treatments across the HF continuum. Therapy for risk factors that predispose patients to left ventricular dysfunction or other symptoms may help reduce HF development. beta-Blockers are valuable for treatment of HF; however, the class Is heterogeneous, and proper beta-blocker selection for each HF stage Is Important. beta-Blockers have been used routinely to treat patients with stage A HF with hypertension. Recent controversy regarding the detrimental effects that some beta-blockers have on metabolic parameters has raised Inappropriate concerns about the use of any beta-blocker for diabetes. beta-Blockade Is standard therapy for the patient with stage a HF who has had a myocardial Infarction, but few data are available concerning use In asymptomatic patients with left ventricular dysfunction. Additionally, beta-blockers are part of the core therapy for stage C HF and selected patients with stage D HE This review examines the role and use of beta-blockers In each HF stage through an evidence-based approach to provide better understanding of their Importance In this progressive disease. PubMed searches (1980-2008) identified large clinical trials that evaluated cardiovascular events and outcomes In any HF stage or hypertension. Search terms were heart failure, hypertension, beta-blocker, ACEI, ARS, and calcium channel blocker AND blood pressure coronary artery disease, diabetes, efficacy, left ventricular dysfunction, metabolism, mortality, myocardial Infarction, or stroke.