Beta-adrenergic blocking agents in heart failure

Abstract

Cardiac dysfunction in heart failure is widely recognized as a progressive process, regardless of the clinical signs and symptoms. An increase in cardiac sympathetic drive is one of the earliest neurohormonal responses occurring in patients with heart failure and may be one of the major causes of the progressive remodeling leading to the decline in myocardial function, and responsible for the poor prognosis of patients with heart failure. Therefore, recent data provided by several appropriately designed clinical trials clearly indicate the benefits of beta-adrenoceptor blocking agents, combined with diuretics, ACE inhibitors, and digoxin in chronic heart failure class II to IV due to systolic ventricular dysfunction. The benefits are related to symptoms, functional capacity, remodeling, and improvement in left ventricular function, reduction in cardiovascular hospitalization, a decrease in the overall and sudden cardiac death rate, and are similar in patients with ischemic or nonischemic cardiomyopathy, independent of age, gender, or functional class. In this review we describe the cardiovascular effects of the increase in sympathetic drive, the pharmacological properties of the beta-blockers most evaluated in heart failure therapy (metoprolol, bisoprolol, and carvedilol), the major clinical trials related to these agents in heart failure, the recommendations for their appropriate use in clinical practice, the precautions to be adopted, and how to handle the more common adverse reactions.

Chronic heart failure: a review of pharmacotherapy management

“…β-blockers (eg, bisoprolol, carvedilol, sustained-release metoprolol succinate) are also considered first-line drugs in the treatment of HFrEF because they reduce overall mortality, death from HF and sudden death, in addition to improving symptoms and reducing recurrence rates hospitalizations for HF (Marcondes-Braga et al, 2021). β-blockers can preserve myocardial structure and function due to the fact that they prevent the increase in the concentration of the cyclic AMP second messenger and the myocardial Ca2+ overload, as well as by decreasing the activation of Ca2+-dependent ATPase enzymes and, consequently, the reduction of highly energetic phosphates, resulting from the stimulation of adrenergic receptors (Batlouni & Albuquerque, 2000).…”

“…β-adrenergic blockade can decrease cardiac arrhythmias by reducing heart rate, improving ventricular function, reducing cardiac automaticity and preventing hypokalemia. The long-term use of β-blockers in patients with CHF induces important and beneficial effects such as, for example, an increase in left ventricular ejection fraction, a progressive reduction in left ventricular volumes and myocardial mass and reduces mitral regurgitation, which may reverse changes related to ventricular remodeling (Batlouni & Albuquerque, 2000).…”

Anais do I Congresso Multidisciplinar do UniSantaCruz

“…Já sobre o tratamento medicamentoso, o uso de fármacos da classealfa bloqueadores causam benefício imediatos dos sintomas (Batlouni & Albuquerque, 2000).Para pacientes com sintomas obstrutivos leves a moderados, os bloqueadores alfas adrenérgicos (terazosina, doxasosina, tansulosina, alfuzosina) podem melhorar a micção, de forma que relaxam os músculos da próstata e da saída da bexiga, melhorando o fluxo da urina (Oliveira, Rodrigues, & Paula, 2007).As reações adversas dos betabloqueadores são efeitos colaterais descritos como fadiga, depressão, capacidade de exercício diminuída, disfunção sexual e crises de asma (Bortolotto & Consolim-Colombo, 2009).…”

Perfil epidemiológico, aptidão cardiopulmonar e qualidade de vida relacionada à saúde de pacientes com insuficiência cardíaca

“…Quanto ao perfil medicamentoso da amostra do estudo, os betabloqueadores (86,1%) foram frequentemente prescritos. Diversos estudos têm demonstrado a utilização crescente dos betabloqueadores no manejo clínico da IC (BATLOUNI et al, 2009;FREITAS, 2008;NOGUEIRA, et al,2010;PENA, et al,2011).…”