β Blockade in congestive heart failure: persistent adverse haemodynamic effects during chronic treatment with subsequent doses

Objective To determine whether the acute adverse haemodynamic effects of β blockade in patients with congestive heart failure persist during chronic treatment. Design Sequential haemodynamic evaluation of heart failure patients at baseline and after three months of continuous treatment with the β1 selective antagonist metoprolol. Setting Cardiac care unit in university hospital. Patients 26 patients with moderate to severe congestive heart failure (New York Heart Association grade II to IV) and background treatment with digoxin, diuretics, and angiotensin converting enzyme inhibitors, and with a left ventricular ejection fraction