[Use of beta-blockers in heart failure].

: Recently, a number of clinical trials showed that beta-blockers reduce morbidity and mortality in patients with heart failure. Possible mechanisms for this effect of beta-blockers include protection from catecholamine myocyte toxicity, upregulation of beta-adrenergic signaling, attenuation of apoptosis, reduction in myocardial oxygen demand, and antiarrhythmic effect. Metoprolol, bisoprolol, and carvedilol are proved to have substantial benefit in the treatment of heart failure by large-scale studies. In patients with moderate to severe heart failure, these drugs have to be started slowly and to be uptitrated gradually while watching for deterioration of heart failure. Cardiac contraindications include severe bradycardia, high-degree heart block, and decompensated heart failure. In spite of those adverse effects, beta-blocker should be actively adopted in the treatment of heart failure.