The use of metoprolol CR/XL in the treatment of patients with diabetes and chronic heart failure

About 5 million Americans suffer from heart failure. Given the correlation of heart failure with age and the rising life expectancy, the prevalence of heart failure continues to increase in the general population. Sympathetic stimulation intensifies with progressive heart failure. The rationale to use beta-blockers in individuals with impaired myocardial function is based on experimental evidence supporting the notion that prolonged alpha- and beta-adrenergic stimulation leads to worsening heart failure. Until recently, safety concerns have precluded the use of beta-blockers in patients with diabetes and heart failure. However, several large, randomized, placebo-controlled clinical trials such as Metoprolol Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF) have shown that beta-blockers can be safely used in patients with diabetes and heart failure. Moreover, beta-blockers significantly improved morbidity and mortality in this population. Based on this evidence, it is now recommended to add beta-blockers such as metoprolol CR/XL with an escalating dosage regimen to the treatment of patients with symptomatic heart failure who already are receiving a stable medical regimen including angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, diuretics, vasodilators, or digitalis.