Analysis of Clinical Efficacy and Adverse Effects of β-Blocking Agents Used Clinically for Chronic Heart Failure

Abstract

Clinical efficacy and adverse effects of the β-blocking agents, carvedilol, bisoprolol, and metoprolol were analyzed theoretically, and then compared quantitatively, for the purpose of determining their proper use for chronic heart failure. Initially, we evaluated occupancy binding to the β 1 and β 2 receptors (Фss β 1 and Фss β 2 ) by these drugs. Thereafter, we examined the relationship between Фss β 1 values and left ventricular ejection fraction (LVEF) increase rate to determine efficacy. The result showed that the efficacy with carvedilol could be attained with a lower Фss β 1 value than the others. Therefore, we constructed a model under the assumption that β-blocking agents exert both indirect action of LVEF increase through the β 1 receptor and direct action on ryanodine receptor 2. Using the model, it was suggested that these drugs have no differences in regard to the efficacy, while it was clarified theoretically that only carvedilol produces an effect that directly involves ryanodine receptor 2 at clinical doses. We also investigated decreases in heart rate and forced expiratory volume in 1 s as adverse effects of β-blocking agents using a ternary complex model. It was indicated that carvedilol is less likely to induce a heart rate decrease. Meanwhile, it was also suggested that the risk of an asthmatic attack was higher for carvedilol at clinical doses. Our results are considered useful for selection of a proper β-blocking agent and its administration at a reasonable dose for successful heart failure therapy.

The Impact of Chronic Oral Beta-Blocker Intake on Intravenous Bolus Landiolol Response in Hospitalized Intensive Care Patients with Sudden-Onset Supraventricular Tachycardia—A Post Hoc Analysis of a Cross-Sectional Trial

“…The majority of our patients (n = 9) in the Lβ group had Bisoprolol as a prior therapy, and, as other studies have already shown, Bisoprolol already occupies > 80% of the receptors very quickly and for a long time [ 32 , 34 ]; therefore, we would assume here that Landiolol (in combination with Bisoprolol) would have a significantly improved effectiveness in lowering the heart rate compared to Landiolol without prior oral β-blocker therapy (similar to the study by de May et al with Celiprolol in healthy subjects) [ 32 ].…”

“…The degree of β1-receptor occupancy also appears to be dose-dependent. For example, the occupancy of β1 receptors increases after Bisoprolol administration from 24% at 0.625 mg to 71.6% at 5 mg [ 34 ]. This effect may be desirable in the context of chronic diseases (e.g., myocardial infarction, heart failure, hypertension) but is not always desirable in the acute setting.…”