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Benefits of beta-blockers in heart failure: a class specific effect?

There is now compelling evidence in favor of the use of beta-adrenergic antagonists for the treatment of chronic heart failure. In clinically stable patients who remain symptomatic despite the fact that they are already receiving an angiotensin-converting enzyme inhibitor, diuretics and digoxin, the addition of a beta-blocker has been shown to produce further improvements in cardiac function and structure as well as in the quality and quantity of life. However, although such benefits can be achieved with a number of beta-blockers, the relevant differences in the ability of inhibiting the adrenergic drive among the various agents in the same class could translate into quantitatively different clinical effects. At present, the question whether all beta-blockers confer equal benefit or not to heart failure patients remains unanswered, since only few studies have prospectively addressed the issue and overall evidence does not permit to draw a conclusion that one agent has to be preferred to another. A large ongoing trial, designed to compare the effects of metoprolol and carvedilol on all-cause mortality in chronic heart failure, will provide much of the information required.