beta-blocker in Heart failure with reduced ejection fraction: A review

Heart failure, a major public health problem is associated with high mortality, poor quality of life, and frequent hospitalization. It is a complex syndrome characterized by neurohumoral activation. Activation of sympathetic nervous system plays an important role in its pathogenesis. Randomized trials have show that beta-blockers reduce mortality, hospitalization and improves quality of life. One of the three beta-blockers (i.e., bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended for all patients with current or prior symptoms of Heart Failure, unless contraindicated, to reduce morbidity and mortality. beta-blockers are underused in patients with heart failure. If a patient is considered suitable for beta-blocker therapy, a careful initiation and gradual increases of beta-blocker dose are crucial to avoid clinical deterioration. Initiating the Angiotensin Conventing Enzyme inhibitor first is traditional but studies have proven similar safety with a beta-blocker-first strategy. Emerging evidence suggests that the order of initial ACEI or beta-blocker therapy may not matter.