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The Fear of -Blocker Therapy in Heart Failure

Time to Forget

Arch Intern Med. 2004;164:1370-1371.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

More than 25 years ago, Swedish physicians reported that -blocker therapy can improve symptoms and ventricular function in patients with overt heart failure due to dilated cardiomyopathy.¹ These reports created substantial disbelief and skepticism among cardiologists and practicing physicians. The pharmacodynamic effects of -blockers, such as decrease in heart rate, blood pressure, and contractile function, were already established. It is not surprising, therefore, that physicians were not only hesitant but also afraid to use -adrenergic blocking agents, which have the potential to cause worsening heart failure due to their negative inotropic effects.

Bradycardia has also been considered an adverse effect of -blocker therapy because bradycardia may decrease cardiac output in patients with systolic heart failure. It has not been appreciated for many years, however, that some reduction in heart rate is beneficial in improving depressed left ventricular systolic function by reversing the inverse force frequency relation that has been documented . . . [Full Text of this Article]

Kanu Chatterjee, MB, FRCP(Lond), FRCP(Edin)