Current issues regarding beta-adrenergic blockade in patients with congestive heart failure: patient selection, nonselective versus selective blockade, management of adverse effects, and indications for withdrawal of therapy.

Neurohormonal activation and chronic adrenergic overstimulation appear to play important roles in mediating the progressive pathophysiology of congestive heart failure (CHF), and the beneficial effects of beta-blockade in the management of chronic heart failure have been demonstrated by multiple clinical trials over the last decade. Nevertheless, the initiation and maintenance of beta-blocker therapy in CHF may initially precipitate a deterioration in clinical function, and numerous questions regarding the appropriate use of these agents in patients with heart failure remain. This report examines the practicalities of beta-adrenergic blockade in heart failure, focusing on patient selection, nonselective versus selective blockade, management of adverse effects, and indications for withdrawal of therapy.