Molecular mechanisms underlying adrenergic dysfunction in aging and heart failure: Clinical and therapeutical implications

Chronic heart failure is one of the leading causes of mortality and morbidity worldwide, showing high prevalence rates in the elderly population. Adrenergic system deregulation is a common feature of both chronic heart failure and physiological aging. Sympathetic hyperactivity represents an important compensatory mechanism in the early stages of the syndrome but it becomes detrimental in the long term, causing cardiac adrenergic receptors downregulation/desensitization thus contributing to heart failure progression. Similar dysfunctions can be observed in physiological aging, due to overstimulation of the adrenergic receptors by increased circulating catecholamine levels also in healthy elderly. These evidence indicate that adrenergic receptors blockers play a crucial role in heart failure pharmacological therapy, since they are effective in slowing maladaptive cardiac remodeling and reducing hospitalization and mortality in advanced stages. Thus, the aim of this review is to describe adrenergic system dysfunction and to analyze the issues related to β-blockers use in heart failure therapy in the elderly population.