Beta-blockers for heart failure: Pharmacology, relevance, and justification

Shahid Akbar, John R Richards

Research output: Chapter in Book/Report/Conference proceedingChapter


Clinicians are often faced with the dilemma of how to most efficiently treat heart failure patients, especially regarding the use of β-blockers under different circumstances. The use of β-blockers for heart failure has evolved over the years amid controversies. Beta-blockers were initially introduced into clinical practice to treat angina pectorisrelated morbidity and mortality. The use of β-blockers for heart failure was counterintuitive, and these drugs remained contraindicated for a good length of time, due to the perceived negative effects of reduced contractility and heart rate on a failing heart. However, clinical evidence based on large randomized controlled clinical trials from the past few decades, and the development of new β-blockers has proven their worth in heart failure patients. The earliest controlled clinical study, the Beta-Blocker-Heart-Attack Trial (BHAT), found that β-blockers were not more likely to cause heart failure if started within three weeks of myocardial infarction than placebo, and this set the ball rolling for future landmark trials establishing the efficacy of β-blockers in patients with heart failure. However, only three β-blockers, bisoprolol, sustained-release metoprolol succinate, and carvedilol have emerged to be effective in reducing the combined risk of death and hospitalization in heart failure patients with or without ischemic heart disease, with or without diabetes, and in women and Black patients. This chapter reviews the published evidence of the utility, choices, and limitations of β-blockers within the broad context of heart failure.

Original languageEnglish (US)
Title of host publicationBeta-Blockers
Subtitle of host publicationPhysiological, Pharmacological and Therapeutic Implications
PublisherNova Science Publishers, Inc.
Number of pages44
ISBN (Electronic)9781536133127
ISBN (Print)9781536133110
StatePublished - Jan 1 2018

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology, Toxicology and Pharmaceutics(all)


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