β-Blockers in hypertension, diabetes, heart failure and acute myocardial infarction: a review of the literature

Abstract

β-Blockers (BBs) are an essential class of cardiovascular medications for reducing morbidity and mortality in patients with heart failure (HF). However, a large body of data indicates that BBs should not be used as first-line therapy for hypertension (HTN). Additionally, new data have questioned the role of BBs in the treatment of stable coronary heart disease (CHD). However, these trials mainly tested the non-vasodilating β1 selective BBs (atenolol and metoprolol) which are still the most commonly prescribed BBs in the USA. Newer generation BBs, such as the vasodilating BBs carvedilol and nebivolol, have been shown not only to be better tolerated than non-vasodilating BBs, but also these agents do not increase the risk of diabetes mellitus (DM), atherogenic dyslipidaemia or weight gain. Moreover, carvedilol has the most evidence for reducing morbidity and mortality in patients with HF and those who have experienced an acute myocardial infarction (AMI). This review discusses the cornerstone clinical trials that have tested BBs in the settings of HTN, HF and AMI. Large randomised trials in the settings of HTN, DM and stable CHD are still needed to establish the role of BBs in these diseases, as well as to determine whether vasodilating BBs are exempt from the disadvantages of non-vasodilating BBs.

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“…The use of BARBs increased the risk of dyslipidemia and atherogenic lipids as this study reports this observation 19 . The significant low serum glucose level that observed in this study does not agree with other studies, which most probably due to the heterogenecity of the prescribed BARBs as DiNicolantonio et al 2015 mentioned 19 . Therefore, one of the limitations of the study is the small number size that does not allow a significant analysis of the effect of each BARBs on the metabolic derangement.…”

A carvedilolterápia előnyei magas cardiovascularis kockázatú betegek kezelése során

“…A vér-nyomáscsökkentő hatáshoz hozzájárul még a praejunctionalis béta-receptorok gátlása, illetve a reninkiáramlás gátlása révén csökken a renin-angiotenzin rendszer aktivitása is [10].…”

“…A béta-2-receptorok "down-regulációja" kisebb mértékű, ezért számuk relatíve nő, a béta-2-hatás fennmaradása pedig gátolja az apoptózist. A béta-blokkolók hatására nő a béta-receptorok száma, amelynek következtében javul a szisztolés funkció [8,10].…”

“…Míg a két szerrel hasonló vérnyomáscsökkenés volt elérhető, addig a carvedilolnak sokkal kedvezőbb anyagcserehatásai voltak [8,10,16].…”

Protective effect of necrostatin-1 on myocardial tissue in rats with acute myocardial infarction

“…The incidence is sudden and the mortality is high; therefore, it has become one of the major diseases leading to death of cardiovascular and cerebrovascular patients (DiNicolantonio et al, 2015;Fordjour et al, 2015). The pathological basis of acute myocardial infarction is that myocardial vascular blockage causes hypoxia and ischemia in myocardial tissue, marked apoptosis, and necrosis of myocardial tissue, eventually disrupting the function of myocardial cells (Malick et al, 2014;Luo et al, 2015).…”