Medical Controversies in the Uses of Beta-Blockers
Walaa Gamal Fahmy Mohamed;
Abstract
Beta-blockers are catecolamine competitive inhibitors and act through alpha and beta adrenergic receptors blockade. Different agents have a dose-dependent affinity for different beta adrenergic receptors (beta 1, beta 2, and beta 3) which is less with higher doses. The most important therapeutic effects of beta-blockers are on cardiovascular system, where they act as negative chronotropic and inotropic agents, lowering cardiac work and improving oxygen demand /supply ratio. Clinical indications are numerous.
Hypertension is an important risk factor for stroke and other cardiovascular events. National and international guidelines recognize five classes of drugs for the first-line treatment of hypertension, but the effectiveness of beta blockers has recently been questioned, especially in the elderly. However, achieving a lower blood pressure is more important than the choice of drug used in treatment. Many patients will need more than one drug to treat their hypertension. Beta blockers remain important and effective drugs, but age and comorbidities need to be considered when selecting a first-line drug.
For patients with acute myocardial infarction, beta blocker therapy reduces infarct size and early mortality when started early and lowers the risk of death when continued long term.
The safety of beta-blockers in pulmonary hypertention is controversial. Old reports suggested that beta-blockers may be harmful in these patients; recent data suggested no harmful or even protective effects of beta-adrenergic receptor antagonists.
Beta-blocker use is safe in patients with obstructive airway disease and is associated with significant reduction in mortality and exacerbation of COPD, and this effect is likely to be greater in patients with pre-existing heart disease. Considering the benefits of beta-blockers in conditions like hypertension, heart failure and coronary artery disease, these drugs should not be withheld because of COPD.
Whether beta blockers in perioperative care are protective, safe or harmful continues to be a subject of debate. In the meantime, the current position is that "the initiation of beta blockers in patients who will undergo non-cardiac surgery should not be considered routine, but should be considered carefully by each patient's treating
Hypertension is an important risk factor for stroke and other cardiovascular events. National and international guidelines recognize five classes of drugs for the first-line treatment of hypertension, but the effectiveness of beta blockers has recently been questioned, especially in the elderly. However, achieving a lower blood pressure is more important than the choice of drug used in treatment. Many patients will need more than one drug to treat their hypertension. Beta blockers remain important and effective drugs, but age and comorbidities need to be considered when selecting a first-line drug.
For patients with acute myocardial infarction, beta blocker therapy reduces infarct size and early mortality when started early and lowers the risk of death when continued long term.
The safety of beta-blockers in pulmonary hypertention is controversial. Old reports suggested that beta-blockers may be harmful in these patients; recent data suggested no harmful or even protective effects of beta-adrenergic receptor antagonists.
Beta-blocker use is safe in patients with obstructive airway disease and is associated with significant reduction in mortality and exacerbation of COPD, and this effect is likely to be greater in patients with pre-existing heart disease. Considering the benefits of beta-blockers in conditions like hypertension, heart failure and coronary artery disease, these drugs should not be withheld because of COPD.
Whether beta blockers in perioperative care are protective, safe or harmful continues to be a subject of debate. In the meantime, the current position is that "the initiation of beta blockers in patients who will undergo non-cardiac surgery should not be considered routine, but should be considered carefully by each patient's treating
Other data
| Title | Medical Controversies in the Uses of Beta-Blockers | Other Titles | الإختـلافـات الطبيـة في إستـخدام (مثبطات مستقبلات البيتا) | Authors | Walaa Gamal Fahmy Mohamed | Issue Date | 2017 |
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