β-BLOCKER THERAPY IN HEART FAILURE - 03/09/11

Doi : 10.1016/S0733-8651(05)70212-5

Peter Carson, MD ^{^{*
Department of Veterans Affairs Medical Center, Georgetown University Hospital, Washington, District of Columbia}}

Résumé

Congestive heart failure remains a complex pathophysiologic syndrome associated with significant morbidity and mortality. Although advances in therapy, particularly with vasodilators, have improved prognosis, progression of heart failure occurs in most patients, and the role of neurohormonal stimulation has taken on increasing importance. The renin-angiotensin system is activated in heart failure and has been the target of the angiotensin-converting enzyme inhibitors, the most proven drugs in heart failure.^{14 CONSENSUS Trial Study Group Effects of enalapril on mortality in severe heart failure: Results of the Co-operative North Scandinavian Enalapril Survival Study (CONSENSUS) N Engl J Med 1987 ; 316 : 1429-1435

Cliquez ici pour aller à la section Références, 44 The SOLVD Investigators Effect of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive heart failure N Engl J Med 1991 ; 325 : 293-302

Cliquez ici pour aller à la section Références} Increasingly the crucial role of the sympathetic nervous system has been recognized: Catecholamines are markers for advanced heart failure but also exert toxic effects.^{37 Packer M., Bristow M.R., Cohn J.N. , et al. for the US. Carvedilol Heart Failure Study Group The effect of carvedilol on morbidity and mortality in patients with chronic heart failure N Engl J Med 1996 ; 334 : 1349-1355 [cross-ref]

Cliquez ici pour aller à la section Références} More recently, there has been increasing attention to the pathologic remodeling^{23 Greenberg B., Quinones M.A., Koilpillai C. , et al. for the SOLVD Investigators Effects of long-term enalapril therapy on cardiac structure and function in patients with left ventricular dysfunction Circulation 1995 ; 91 : 2573-2581

Cliquez ici pour aller à la section Références} in heart failure that contributes to the progression of the syndrome. β-Blocker drugs are neurohormonal antagonists and also appear to remodel the failing ventricle.^{24 Hall S.A., Cigarroa C.G., Marcous L. , et al. Time course of improvement in left ventricular function, mass and geometry in patients with congestive heart failure treated with beta-adrenergic blockade J Am Coll Cardiol 1995 ; 25 : 1154-1161 [cross-ref]

Cliquez ici pour aller à la section Références} Early reports suggested clinical efficacy,^{7 Bristow M.R., Ginsburg R., Umans V. , et al. Beta 1- and beta 2-adrenergic subpopulations in nonfailing and failing human ventricular myocardium: Coupling of both receptor subtypes to muscle contraction and selective beta 1-receptor downregulation in heart failure Cir Res 1986 ; 59 : 297-309

Cliquez ici pour aller à la section Références} and subsequent data have shown evidence that the progression of heart failure might be prevented or even reversed.^{8 Bristow M.R., O'Connell J.B., Gilbert E.M. , et al. for the Bucindolol Investigators Dose-response of chronic beta blocker treatment in heart failure from either idiopathic dilated or ischaemic cardiomyopathy Circulation 1994 ; 89 : 1632-1642

Cliquez ici pour aller à la section Références} The effect of β-blockade on these processes has added to growing interest in these agents for the therapy of heart failure.

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Plan

HEART FAILURE AND MYOCARDIAL CONTRACTION

PHARMACOLOGIC DIFFERENCES IN β-BLOCKERS

β-Blockers and Mortality

β-BLOCKERS

	Portions of this article appeared in The Cardiology Clinics: Annual of Drug Therapy, Vol. 3, 1999.
	Address reprint requests to Peter Carson, MD, Department of Veterans Affairs Medical Center, 50 Irving Street NW, Washington, DC 20422