Inotropes and β-blockers: Is there a need for new guidelines?

Michael R. Bristow, Simon F. Shakar, Jennifer V. Linseman, Brian D. Lowes

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


β-Adrenergic blocking agents are standard treatment for patients with mild-to-moderate heart failure. When patients receiving β-blockers decompensate they often need treatment with a positive inotropic agent. The β-agonist dobutamine may not produce much increase in cardiac output during full-dose β-blocker treatment and may increase systemic vascular resistance via α-adrenergic stimulation. In contrast, phosphodiesterase inhibitors (PDEIs) such as milrinone or enoximone retain full hemodynamic effects during complete β-blockade because the site of action of PDEIs is beyond the β-adrenergic receptor and because β-blockade reverses some of the desensitization phenomena that account for the attenuation of PDEI response in heart failure related to upregulation in Gαi. Inotrope-requiring subjects with decompensated heart failure who are undergoing long-term therapy with β-blocking agents should be treated with a type III-specific PDEI, not a β-agonist such as dobutamine.

Original languageEnglish (US)
Pages (from-to)8-12
Number of pages5
JournalJournal of Cardiac Failure
Issue number2 PART II
StatePublished - 2001
Externally publishedYes


  • Contractility
  • Heart failure
  • Inotropes
  • β-blockers

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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