How beta-blockers treat diastolic heart failure

Beta-blockers have been shown to reduce symptoms and improve survival in people with systolicheart failure. Beta-blockers can also be helpful for people with diastolic heart failure.

One of the main causes of diastolic dysfunction is that the heart does not have enough time to relax and fill before pumping blood out to the rest of your body. By slowing your heart rate and reducing the force of contraction of each beat of your heart, beta-blockers allow more time for your heart to fill with blood and can thus improve the function of the heart in a person with diastolic heart failure. Beta-blockers also can lower your blood pressure and can slow thickening of the heart muscle (hypertrophy) caused by high blood pressure, which is another major cause of diastolic heart failure.

Common side effects of beta-blockers include:

• Worsening of heart failure.By reducing the heart rate and the force of contraction of your heart, beta-blockers can initially diminish the function of your heart and can sometimes make your heart failure worse. In fact, it is common for people to notice that their symptoms get a bit worse during the first few weeks of treatment with beta-blockers. If you start taking one of these medicines for your heart failure, you will need to see your doctor more often in the beginning so that your medicines can be adjusted and your condition evaluated. If your heart failure is severe, you may not be able to tolerate beta-blockers at all.
• Aggravation of peripheral arterial disease.If you have severe peripheral arterial disease (blockages in arteries of your legs), you may not be able to take an adequate dose of a beta-blocker for your heart failure. Fortunately, this is not a common limitation to the use of beta-blockers.
• Abnormally slow heartbeat.Although slowing the heart rate can be beneficial to you if you have diastolic heart failure or coronary artery disease, slowing your heart rate too much can be counterproductive if you have systolic dysfunction because this can further reduce the amount of blood pumped by your heart. A heart rate that is too slow can make you feel weak or dizzy. Monitoring the heart rate is one of the reasons why you will need to see your doctor more often when you first start taking a beta-blocker.

The decision about whether to use beta-blockers to treat heart failure can be a difficult one because you will need to weigh the great potential benefit of these drugs against the risk of possible side effects. Your doctor will be able to help you evaluate the risks and benefits that are specific to you and will help you make the best decision.