β-Blocker Use for the Stages of Heart Failure

The 2005 American Heart Association/American College of Cardiology heart failure (HF) guidelines contributed to a renewed focus on “at-risk” patients and emphasized HF as a progressive disease. Patient categorization by stages focused attention on customization of therapy to achieve optimal, evidence-based treatments across the HF continuum. Therapy for risk factors that predispose patients to left ventricular dysfunction or other symptoms may help reduce HF development. β-Blockers are valuable for treatment of HF; however, the class is heterogeneous, and proper β-blocker selection for each HF stage is important. β-Blockers have been used routinely to treat patients with stage A HF with hypertension. Recent controversy regarding the detrimental effects that some β-blockers have on metabolic parameters has raised inappropriate concerns about the use of any β-blocker for diabetes. β-Blockade is standard therapy for the patient with stage B HF who has had a myocardial infarction, but few data are available concerning use in asymptomatic patients with left ventricular dysfunction. Additionally, β-blockers are part of the core therapy for stage C HF and selected patients with stage D HF. This review examines the role and use of β-blockers in each HF stage through an evidence-based approach to provide better understanding of their importance in this progressive disease. PubMed searches (1980-2008) identified large clinical trials that evaluated cardiovascular events and outcomes in any HF stage or hypertension. Search terms were heart failure, hypertension, β-blocker, ACEI, ARB, and calcium channel blocker AND blood pressure coronary artery disease, diabetes, efficacy, left ventricular dysfunction, metabolism, mortality, myocardial infarction, or stroke.