The syndrome of CHF is likely the final common
pathway for a number of myocardial insults,
including myocardial ischaemia/infarction, hypertension,
valvular disease and idiopathic cardiomyopathy.
The compensatory neurohormonal mechanisms
which are initially activated in CHF serve to
maintain cardiac output, but may ultimately contribute
to further deterioration of ventricular function
(the so-called neurohormonal hypothesis).[11]
The 2 neurohormonal systems which are activated
in CHF are the renin-angiotensin-aldosterone system
(RAAS) and the sympathetic nervous system
(SNS). Pharmacological interventions which reduce
this activation may have a beneficial effect on the
progression of CHF. This is, in part, supported by
robust clinical trial evidence on the efficacy of ACE
inhibitors[8] and, to a lesser extent, by the angiotensin
receptor antagonists.[12] The purpose of this article
is to review the current literature on the use of
-blockers in patients with CHF