Dear Colleagues,  

Beta-blockers are among the most important medical discoveries in the treatment of the disorders of circulation of the last 30 years. They were initially developed in Britain, by British pharmacologists and by an English pharmaceutical firm. Since the initial investigations, the drugs have performed very important functions, to begin with in the therapy of cardiac arrhythmias and later in the treatment of coronary syndromes, including myocardial infarction. The reduction in mortality, diminution in the need for hospitalization for recurring major events, and improvement in the quality of life resulting from their effects have prompted heavy use in many cardiac disorders. 
In a later development, the seminal observations of Dr.Waagstein and his Swedish colleagues from Gothenburg (Göteborg) demonstrated, in spite of initially negative reactions from a significant part of the medical community, the important actions of beta-blockers in the field of heart failure. 
From the beginning, Professor Philip Poole-Wilson and his coworkers have shown profound interest in this topic, and very important contributions have come out of the Imperial College, home of Philip.
So it seemed logical that, for this new Series of concise reviews, Hot Topics in Cardiology, the Scientific Committee would ask Philip and his team to contribute with a paper on beta-blockers in heart failure. Any cardiologist or internist with an interest in cardiology will appreciate the very fine work of our English colleagues. 
After an initial brief and very appropriate analysis of the conceptual development of the use of beta-blockers in heart failure, the paper presents a very clear but sound review of β adrenergic signalling and β adrenergic receptor function in the normal heart and in heart failure. 
The differences between the several types of receptors, not only in the clinical setting but also in the experimental field, are a very pertinent introduction to the use of the beta-blocking compounds in cardiac insufficiency. Their use is founded on selectivity of the different receptors in terms of affinity due to receptor conformation and the resulting interactions with particular G protein families. 
What follows is an exhaustive presentation of the various clinical trials in heart failure conducted between 1994 and 2005, showing the effect of beta-blockers on survival, need for hospitalization, and quality of life. The role of dosage and the methods of titration are clearly stressed to obtain the best results and avoid unnecessary side effects during treatment initiation. The differences between the various beta-blockers seem to emphasize the notion that a class effect is only a very partial view of their mechanism of action. 
Several tables and an important number of references make this monograph henceforward an indispensable companion for all physicians-cardiologists and internists-wishing to obtain the best therapeutic results from this fundamental treatment of heart failure.