Controversies in the use of beta blockers in heart failure.

Recent evidence from randomized controlled trials has provided compelling evidence to support the use of beta blockers in most patients with heart failure due to systolic dysfunction. There is little disagreement about the mortality benefit provided by adding beta blockers to standard therapy, which may include angiotensin-converting enzyme inhibitors, diuretics, and sometimes digoxin. A few areas are still controversial. The authors review the available literature encompassing four of those controversial areas: 1) the comparability among beta blockers; 2) the utility of beta blockers among patients with New York Heart Association class I and class IV heart failure symptoms; 3) the impact of race on the effectiveness of beta blockers; and 4) the safety and efficacy of beta blockers among patients on concomitant therapy with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or spironolactone.