ß-blokkers geïndiceerd bij patiënten met hartfalen

- Until recently, beta-blocking drugs were considered to be contraindicated in patients with chronic heart failure. However, several well-conducted randomised clinical trials have now proven otherwise. Yet, it was still not clear whether non-selective α-, β₁- and β₂-receptor blockade with carvedilol would be superior to selective β₁-receptor blockade with metoprolol. One of the studies (‘Carvedilol or metoprolol European trial’ (COMET)) demonstrated a statistically significant 17 reduction of all-cause mortality with carvedilol. Although striking, the results may have been influenced by differences in blood pressure and heart rate, as well as the short-acting formula of metoprolol that was used. Furthermore, the ‘Carvedilol hibernation reversible ischaemia trial; marker of success’ (CHRISTMAS) study demonstrated myocardial hibernation in the majority of ischaemic heart-failure patients, and showed beneficial effects on left-ventricle function with carvedilol in both hibernated and non-hibernated patients. Despite this and the rest of the overwhelming evidence, at present only a minority of eligible chronic heart-failure patients are treated with beta-blockers.