β-Blockade for Patients with Hypertension, Ischemic Heart Disease or Heart Failure: Where are We Now?

Abstract

β-blockers are a heterogeneous class of drugs, with varying selectivity/specificity for β 1 vs β 2 receptors, intrinsic sympathomimetic activity (ISA), and vasodilatory properties (through β 2 stimulation, α receptor blockade or nitric oxide release). These drugs are indicated for the management of arterial hypertension, heart failure or ischemic heart disease (IHD; eg angina pectoris or prior myocardial infarction). Most of the benefit of β-blockade in these conditions arises from blockade of the β 1 receptor, and, in practice, the addition of ISA appears to reduce the potential for improved clinical outcomes in people with heart failure or IHD. Aspects of the benefit/risk balance of β-blockers remain controversial, and recent meta-analyses have shed new light on this issue. We have reviewed the current place of cardioselective β-blockade in hypertension, IHD and heart failure, with special reference to the therapeutic profile of a highly selective β 1 -adrenoceptor blocker, bisoprolol.

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

“…In other studies, no substantial differences were shown for selective and non-selective BBs in the treatment of subjects with ischemic heart disease ( 83 ). Moreover, no clear scientific reasons support this choice; in fact, guidelines suggest the use of a BB without an intrinsic sympathomimetic activity, independently of its selectivity; for this reason, nebivolol should be avoided in patients affected by HF and ischemic heart disease ( 84 , 85 ). The large number of studies highlighting the efficacy of carvedilol in reducing morbidity and mortality in patients affected by ischemic heart disease, and the poor amount of evidence concerning bisoprolol could have led physicians to choose carvedilol instead of other BBs in this group of patients ( 86 ).…”

To Evaluate the ‘Real World’ Clinical Performance of Bisoprolol in Post-Myocardial Infarction with Left-Ventricular Dysfunction: TENACITY Study

“…Reduced HR is associated with improved prognosis in patients with HF. ESC guidelines for the management of chronic IHD include a target for resting HR of 55-60 bpm, and US guidelines have recommended a target for HR of 50-60 bpm in these patients [4]. However, there is no clear consensus regarding the appropriate time to initiate treatment with β-blockers in patients with acute coronary syndrome (ACS).…”

“…Oral beta (β)-blockers have been an important part of primary pharmacotherapy and secondary prevention following acute myocardial infarction (AMI) irrespective of its severity, since almost 40 years. [1][2][3] Major guidelines recommend β-blocker therapy early after AMI in the absence of contraindications such as acute heart failure or risk of cardiogenic shock [4]. Early beta blockade (within 24 h of presentation) in AMI has been shown to improve patient outcomes [5].…”

Beta-blockers in cardiac arrhythmias–Clinical pharmacologist’s point of view

“…It is the ability to partially stimulate the β-adrenergic receptor despite its blocking. As a result, a negative inotropic effect is exerted with a much weaker negative chronotropic effect, which is of particular importance for heart failure ( Pathak and Mrabeti, 2021 ). In this disease entity, despite the well-established position of NT-proBNP as a diagnostic and prognostic marker, new, cheaper markers such as procalcitonin, catestatin or RDW (red cell distribution width) are still being searched for, which can also be used as a predictive factor in this disease entity ( Wołowiec et al, 2016 ; Banach et al, 2018 ).…”