β-blocker therapy in Takotsubo syndrome: Current evidence and future perspectives

Introduction: Takotsubo syndrome (TTS) is an acute, stress-induced form of transient left ventricular dysfunction, most commonly triggered by emotional or physical stress, and may mimic various acute cardiac conditions at initial presentation. Despite increasing recognition, optimal long-term pharmacological management remains uncertain, particularly regarding the role of β-blocker therapy. Methodology: This narrative review was based on a literature search performed in PubMed and Google Scholar databases during May 2026. Studies published between January 2008 and April 2026 were considered, including original research articles, meta-analyses, registry data and expert consensus documents addressing the role of β-blockers in Takotsubo syndrome. Topic: β-blocker represent a widely used class of drugs in clinical practice in patients diagnosed with Takotsubo syndrome. The rationale for β-blocker use is based on the hypothesis of catecholamine excess in its pathophysiological basis. However, available evidence regarding their impact on mortality and recurrence is inconsistent. Although β-blockers are indicated in certain clinical situations, such as atrial fibrillation, hypertension, heart failure, left ventricular outflow tract obstruction, and the prevention and treatment of arrhythmias, their routine use in all patients with TTS is not supported by current evidence from studies. Increasing evidence suggests that therapy should be individualized according to the clinical phenotype and associated cardiovascular conditions, rather than the diagnosis of TTS itself. Conclusion: β-blocker therapy in Takotsubo syndrome should be guided by established cardiovascular indications and individual clinical characteristics of patients. Routine long-term use in all patients is not supported by current evidence, highlighting the need for randomized controlled trials to define their exact role in this population.