The Effects of β-Adrenergic Blockers in African Americans with Chronic Heart Failure

Abstract

Objective: To review the available literature regarding the use of β-adrenergic blockers in African Americans with heart failure. Data Sources: Primary literature was located via MEDLINE (1966–January 2004). Key search terms were β-adrenergic blockers; heart failure, congestive; carvedilol; metoprolol; bisoprolol; and bucindolol. Data Synthesis: In African Americans, the prevalence of chronic heart failure (CHF) is nearly twice that of white people. African Americans exhibit symptoms of CHF at an earlier age, develop more marked functional decline after hospitalization for CHF, and have almost a twofold higher mortality rate compared with white patients. Sympathetic nervous system activation is a key pathophysiologic response in CHF; by attenuating this system, β-blockers have been shown to decrease mortality. Unfortunately, minority populations have been underrepresented in many of the trials evaluating β-blockers. Of the 4 β-blockers assessed in CHF, bucindolol has shown detrimental effects when used in African Americans. Metoprolol and bisoprolol have not been sufficiently evaluated to determine if response varies by race. Carvedilol has the best documented benefit in this population. Conclusions: Response to β-adrenergic blockers in CHF varies by race. Bucindolol has shown detrimental effects when used in African Americans. Further investigation is warranted to determine if metoprolol and bisoprolol are equally efficacious to carvedilol in African American patients with CHF.