Beta blocker therapy for congestive heart failure: A rational approach

The use of β blockade for the management of congestive heart failure was first introduced in the 1970s, explored in depth in the 1990s, and has now become a mainstay of congestive heart failure therapy. In patients with congestive heart failure due to left ventricular systolic dysfunction treated with digitalis, diuretics, and angiotensin-converting enzyme inhibitors, β blockers markedly improve left ventricular ejection fraction, and can also increase submaximal exercise tolerance, as well as resting and exercise hemodynamics. Beta blockers have also been shown to improve survival, reduce cardiac event rates, and decrease hospitalizations. In addition, β blockers are safe and effective in a broad spectrum of symptomatic congestive heart failure patients, ranging from New York Heart Association functional classes II-IV. This paper reviews the rationale and clinical experience with the use of β blockers in congestive heart failure patients, and provides practical guidelines for their initiation and titration in appropriately selected patients.