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Journal of Cardiovascular Pharmacology and Therapeutics
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ß-Adrenergic Blockers in Heart Failure: Review of Mechanisms of Action and Clinical Outcomes

Shiyam Satwani, MD

Divisions of Cardiology, Drexel University College of Medicine, Philadelphia, PA

G. William Dec, MD

Divisions of Cardiology, Massachusetts General Hospital, Boston, MA

Jagat Narula, MD, PhD

Divisions of Cardiology, University of California, Irvine, Irvine, CA

Better understanding of the pathophysiology of heart failure has shifted the treatment of heart failure away from enhancing myocardial contractility to a new paradigm that targets the root cause of disease progression by blocking the adverse effects of excessive neurohormonal activation. ß-Adrenergic receptor-blockers have emerged as a cornerstone in the management of symptomatic heart failure. This article reviews the normal functioning of the ß-adrenergic pathway, the consequences of hyperadrenergism on this crucial signaling pathway, and the mechanisms by which chronic ß-blocker therapy reverses these abnormalities. The clinical evidence from controlled trials of the efficacy of ß-blockers in treating heart failure is summarized. Finally, the concomitant use of ß-blockers and positive inotropic agents in advanced heart failure is discussed.

Key Words: ß-adrenergic pathway • ß-blocker therapy • heart failure

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 9, No. 4, 243-255 (2004)
DOI: 10.1177/107424840400900404
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