Beta-blockers used judiciously are as effective as ACE inhibitors that are proven useful in the management of heart failure. From the 1960s to the 1980s heart failure was a recognized contraindication for the use of beta-blockers. The first documented use of beta-blockers to treat heart failure was carried out by Dr. Finn Waagstein in Sweden in 1973, and he published a report of treat¬ment in seven patients in 1975. About 25 years later his colleague, Dr. Swedberg, made the comment: ‘‘in the light of CIBIS-II, MERIT-HF, and COPERNICUS about 25 years after our initial experience, it is gratifying to realize that beta-blocker therapy now is the best docu¬mented and most effective treatment for chronic heart failure.’’
H. Aldosterone Antagonists
1. Spironolactone (Aldactone)
This drug blocks the effect of aldosterone in the distal renal tubule (see Figure 1 in the chapter Diuretics). In the Rales study the drug caused a 30% reduction in the risk of death in patients with class III and IV heart failure treated with diuretics, ACE inhibitors, and digoxin. Hospitaliza¬tion for recurrent heart failure was significantly reduced. This represents a major breakthrough in the management of severe heart failure.

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