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During the past few years, momentum has been building toward incorporating beta-blockers into routine therapy for congestive heart failure (CHF) to reduce mortality. Initially, there was a question of whether carvedilol might be better than other drugs for this purpose; then a large study documented a beneficial effect for bisoprolol (see JW Feb 15 1999, p. 30, accession number 990202002, and Lancet 1999; 353:9). Now we have a large, industry-sponsored, double-blind, randomized trial of metoprolol.
Researchers in 14 countries enrolled 3,991 patients: Half had previous myocardial infarction; most had New York Heart Association class II or III CHF; average ejection fraction was 28 percent; nearly all were taking diuretics and ACE inhibitors. P…