Revisiting Beta-Blocker Formulation—What’s Old Is New Again

The story of beta-blockade in heart failure represents one of cardiology’s most significant, and controversial, advances. Given the negative inotropic and chronotropic effects, beta-blocker use was thought to be deleterious in congestive heart failure by many. Pioneering clinicians slowly reversed the narrative in the 1980s and 1990s with small, underpowered studies, including the MDC trial, where metoprolol tartrate was compared to placebo.1 Using a target dose of 150mg per day and achieving a mean dose of 108mg per day, metoprolol tartrate was found to reduce a composite of all-cause mortality and need for heart transplant by 34% (p=0.058), driven by the heart transplant outcome.