Design of the Beta-Blocker Evaluation Survival Trial (BEST)

Central to our current understanding of heart failure is the concept that compensatory mechanisms that maintain blood pressure and perfusion ultimately contribute to worsening of ventricular function. Studies of the effect of angiotensin-converting enzyme inhibitors in patients with heart failure are consistent with this paradigm. This manuscript describes a 2,800-patient randomized trial that will definitively determine whether sympathetic nervous system antagonism with a β blocker prolongs the life of patients with moderate to severe heart failure.