the Evolution of a New Treatment Concept – Mechanisms of Action and Clinical Implications

For a long time beta-blockers were considered contraindicated for use in heart failure although some experimental and clinical data already in the 1960s and 1970s suggested a beneficial role for beta-blockers in heart failure. Observations of good tolerability of i.v. beta-blockers in acute myocardial infarction and acute heart failure encouraged us to test beta-blockers also in chronic congestive heart failure. The accumulating knowledge of harmful effects from activated neurohormones and negative long-term effects by inotropic drugs eventually rendered the concept of beta-blocker treatment in heart failure more attractive. Beta-blockers are antiischaemic, antiproliferative, antiapoptotic, attenuate inflammatory cytokine, stabilise electrically unstable myocardium and reverse ventricular remodelling. Recent multicentre trials have definitely proved that beta-blockers reduce mortality and morbidity, are well tolerated and improve quality of life. Even in a subset of severe compensated heart failure beta-blockers have been shown to be safe and to reduce mortality and hospitalisation by 35–50 % in addition to conventional heart failure treatment with diuretics, digitalis and ACE-inhibitors. All patients with stable compensated systolic heart failure should therefore be challenged with a beta-blocker. Once stabi