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Reviews in Cardiovascular Medicine (RCM) is published by IMR Press from Volume 19 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with MedReviews, LLC.
Open Access
Review
Beta-Adrenergic Blocking Drugs in Severe Heart Failure
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1
Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
Rev. Cardiovasc. Med. 2002, 3(S3), 20–26;
Published: 20 May 2002
Abstract
Beta-adrenergic blocking drugs have been shown to improve survival and well-being of
patients with mild to moderate heart failure. In more advanced heart failure, the relationship
between the short-term hemodynamic support afforded by activation of the sympathetic
nervous system and the harm that results from excess sympathetic activation is more
complex. Not all studies of ß-adrenergic blocking drugs or antiadrenergic therapy have
shown benefit. The Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS)
trial has revealed that the combined nonselective ß-adrenergic and -adrenergic receptor
blocking drug carvedilol produces an important salutary effect on the natural history of
advanced heart failure. Mortality was reduced by 35% in the carvedilol group, from an
annual (Kaplan-Meier) rate of 18.5% to 11.4%. All-cause hospitalizations were reduced
by 20% and hospitalization from heart failure by 33%. Even amongst the subgroups at
highest risk, no subpopulation could be identified that did not appear to benefit. The trial
supports extending the population of those with chronic heart failure who should be routinely
treated with ß-adrenergic blocking drugs (in addition to angiotensin-converting enzyme
inhibition therapy) to patients with more advanced disease.
Keywords
Beta-adrenergic blocking drugs
Heart failure
Sympathetic nervous system
Norepinephrine