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enal dysfunction is a frequent comorbidity among patients with chronic heart failure and is closely associated with a worse outcome. Beta-blockade is currently a popular approach to treating a broad spectrum of systolic heart failure, but β-blockers are clinically underutilized in patients with heart failure and concomitant renal dysfunction,1 and prescription rates for β-blockers are inversely related to renal function.2 One reason for this underutilization is a lack of information about the influence of renal dysfunction on the effects of β-blockade therapy for heart failure. The short-term administration of β-blockers often reduces cardiac output and renal blood flow, which can worsen renal function, and many large clinical studies on the long-term effects of β-blockers have excluded patients with advanced renal dysfunction and serum creatinine values >2.0−2.8 mg/dl. Fear of adverse potential and limited information about long-term effects and tolerability might explain the clinical hesitation to administer β-blockers for heart failure and concomitant chronic kidney disease.

We Should Not Hesitate to Use β-Blockers for Systolic Heart Failure With Concomitant Renal Dysfunction