Beta-blockers for heart failure

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Beta-blockers are a class of drugs used to control symptoms of heart failure that are made worse by certain hormones called catecholamines. The body releases these hormones as part of its response to heart failure. For this and other reasons, beta-blockers have been shown to be effective for treating most people who have heart failure.

Beta-blockers have a variety of effects throughout the body. They are used to treat heart disease that causes chest pain, high blood pressure, heart attacks, and cardiomyopathy and irregular, rapid heartbeats (arrhythmia). Beta-blockers are also used to prevent migraine headaches, treat tremors, and control anxiety.

• Beta-blockers may work by slowing the heart rate, which allows the left ventricle (the main pumping chamber of the heart) to fill more completely.
• Some of these medicines may also help open or widen blood vessels in the body. This makes them especially useful in some people with certain forms of heart failure who may also have high blood pressure.

Bisoprolol fumarate, carvedilol, and metoprolol tartrate are some of the beta-blockers that have been tested for use in the treatment of heart failure.

Evidence shows that beta-blocker therapy should be used routinely to treat left ventricular systolic dysfunction in people who are stable and have no symptoms or only mild to moderate heart failure symptoms. Beta-blockers should be used together with other medicines that are usually used to treat heart failure, such as angiotensin-converting enzyme (ACE) inhibitors or diuretics.

Beta-blockers can slow the progression of systolic forms of heart failure in many people. Beta-blockers are also used to treat diastolic heart failure because they decrease the heart rate, which gives the heart more time to relax between beats. This allows the left ventricle to fill more completely and increases the volume of blood that the heart pumps with each heartbeat (ejection fraction).

Certain beta-blockers have been shown to:¹

• Improve the percentage of blood pumped from the left ventricle with each heartbeat (ejection fraction).
• Reduce the need for hospital stays.
• Slow the progression of heart failure.
• Reduce the risk of death caused by heart attack and heart failure.

Beta-blockers are one of four medicines recommended for use in most people who have systolic heart failure. Others include diuretics, ACE inhibitors, and sometimes digoxin.

Beta-blockers may sometimes cause a drop in blood pressure when a person stands up (orthostatic hypotension), resulting in dizziness and, rarely, fainting.

In the past, doctors did not prescribe beta-blockers for people with diabetes because beta-blockers can hide symptoms of low blood sugar (hypoglycemia). But studies have confirmed that many people with diabetes and heart failure benefit from taking beta-blockers. Now, doctors encourage people with diabetes to closely monitor their blood sugar levels when taking beta-blockers, to prevent low-sugar episodes.

Beta-blockers may also slightly increase cholesterol levels.

Other less common side effects

• Slow heartbeats (bradycardia)
• Fluid buildup in the face, hands, legs, and feet
• Listlessness
• Fatigue
• Increased wheezing in people with asthma
• Cold hands and feet

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Beta-blockers are started only after a person's systolic heart failure has been stabilized using ACE inhibitors and diuretics.

The effect of beta-blockers may depend on the dosage used. A lower dose may have a different effect than a higher dose. Beta-blocker therapy should be started at a low dose and increased slowly over time.¹

It may take a few months to see the effects of beta-blocker medicine.

Beta-blockers have been used for many years to treat high blood pressure (hypertension).

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Citations

1. American College of Cardiology and American Heart Association (2005). ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult. Summary article. Available online: http://content.onlinejacc.org/cgi/content/full/46/6/1116.