Beta Blockers in Heart Failure: More Evidence for an Old Friend

Chronic β1-adrenergic receptor overactivation is well known to be an important component of pathologic ventricular remodeling, and evidence-based β-blockers are a clinically effective treatment of HFrEF owing in part to their reverse-remodeling effect. Current HF guidelines recommend the use of β-blockers based on many randomized controlled trials showing a reduced mortality rate > 35%. Although the beneficial effect of β-blocker seems undisputed, whether the target heart rate or target dose is more important in β-blocker therapy is the subject of debate. Meta-analysis showed that heart rate should be considered more important than the actual dose when tailoring β-blocker therapy. In particular, the target resting heart rate might be < 70 beats/min in HF patients. The reason why heart rate reduction is more important than β-blocker dose might be related to the large pharmacogenomic heterogeneity of β-blockers.2