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Beta-blocker use for the stages of heart failure Klapholz MMayo Clin Proc 2009[Aug]; 84 (8): 718-29The 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. beta-Blockers are valuable for treatment of HF; however, the class is heterogeneous, and proper beta-blocker selection for each HF stage is important. beta-Blockers have been used routinely to treat patients with stage A HF with hypertension. Recent controversy regarding the detrimental effects that some beta-blockers have on metabolic parameters has raised inappropriate concerns about the use of any beta-blocker for diabetes. beta-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, beta-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 beta-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, beta-blocker, ACEI, ARB, and calcium channel blocker AND blood pressure coronary artery disease, diabetes, efficacy, left ventricular dysfunction, metabolism, mortality, myocardial infarction, or stroke.|*Practice Guidelines as Topic[MESH]|Adrenergic beta-Antagonists/*administration & dosage/adverse effects[MESH]|Diabetes Mellitus/diagnosis/epidemiology[MESH]|Disease Progression[MESH]|Dose-Response Relationship, Drug[MESH]|Drug Administration Schedule[MESH]|Evidence-Based Medicine[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Heart Failure/*diagnosis/*drug therapy/epidemiology[MESH]|Humans[MESH]|Hypertension/diagnosis/epidemiology[MESH]|Male[MESH]|Randomized Controlled Trials as Topic[MESH]|Risk Assessment[MESH]|Severity of Illness Index[MESH]|Survival Analysis[MESH]|Treatment Outcome[MESH] |
