Beta-blockers in selected heart failure populations.

Despite the overwhelming evidence of the beneficial effect of beta-blockers in systolic heart failure, questions have been raised as to whether they provide similar benefits to women, the elderly, and blacks. Also, concerns about the use of beta-blockers in diabetes, chronic obstructive lung disease, and peripheral vascular disease (PVD) have limited their use in populations with these diseases. A review of the experience generated from the three beta-blocker survival heart failure trials confirms the extension of similar beneficial effects to women, the elderly, blacks, and diabetic patients. There is strong support in the literature for the use of selective beta-blockers in patients with mild to moderate chronic obstructive pulmonary disease and encouraging data on their use in patients with mild to moderate PVD.