Beta-blockers for hypertension. Two recent systematic reviews found first-line beta-blockers to be less effective in reducing the incidence of stroke and the combined endpoint of stroke, myocardial infarction, and death compared to all other antihypertensive drugs taken together. However, beta-blockers might be better or worse than a specific class of drugs for a particular outcome measure so that comparing beta-blockers with all other classes taken together could be misleading.
In addition, these systematic reviews did not assess the tolerability of beta-blockers relative to other antihypertensive medications. We thus undertook this review to re-assess the place of beta-blockade as first-line therapy for hypertension relative to each of the other major classes of antihypertensive drugs.
To quantify the effectiveness and safety of beta-blockers on morbidity and mortality endpoints in adults with hypertension.
We searched eligible studies up to June in the Cochrane Controlled Trials Register, Medline, Embase, and reference lists of reviews, and by contacting hypertension experts. We selected randomised controlled trials which assessed the effectiveness of beta-blockers compared to placebo, no therapy or other drug classes, as monotherapy or first-line therapy for hypertension, on mortality and morbidity endpoints in men and non-pregnant women aged 18 years or older.
At least two authors independently applied study selection criteria, assessed study quality, and extracted data; with differences resolved by consensus. Otherwise, we used the random effects method and investigated the cause of heterogeneity. PubMed Central. Background Beta-blockers refer to a mixed group of drugs with diverse pharmacodynamic and pharmacokinetic properties.
They have shown long-term beneficial effects on mortality and cardiovascular disease CVD when used in people with heart failure or acute myocardial infarction. Beta-blockers were thought to have similar beneficial effects when used as first-line therapy for hypertension. However, the benefit of beta-blockers as first-line therapy for hypertension without compelling indications is controversial.
This review is an update of a Cochrane Review initially published in and updated in Objectives To assess the effects of beta-blockers on morbidity and mortality endpoints in adults with hypertension. We checked reference lists of relevant reviews, and reference lists of studies potentially eligible for inclusion in this review, and also searched the the World Health Organization International Clinical Trials Registry Platform on 06 July Selection criteria Randomised controlled trials RCTs of at least one year of duration, which assessed the effects of beta-blockers compared to placebo or other drugs, as first-line therapy for hypertension, on mortality and morbidity in adults.
Data collection and analysis We selected studies and extracted data in duplicate, resolving discrepancies by consensus. GRADE classifies the certainty of evidence as high if we are confident that the true effect lies. Thromboembolism Aortic Aneurysm More How do beta blocker drugs affect exercise? Updated:Aug 22, Beta blockers With respect to prevention of its most common complication--mortality from coronary heart disease--treatment of hypertension had disappointed.
It is possible that this is due to negative effects of antihypertensives on lipid metabolism. The effects of beta blockers on lipid metabolism can be differentiated principally, in accordance with the classification of beta blockers into those with and those without intrinsic sympathomimetic activity ISAas also selectivity and non-selectivity.
On average, beta-1 selective blockers result in a smaller increase in triglycerides. In the individual case, in particular in the presence of hyperlipoproteinemia, the effects cannot be reliably predicted. Lipoprotein concentrations should be monitored during treatment with beta blockers. If necessary, a change in the agent employed is recommended.
In the case of prevention of a second myocardial infarction, for which various studies have unequivocally shown a reduction in mortality associated with treatment with beta blockers with no ISA, these side effects will, however, be accepted--with the exception of extreme changes--for a limited period of time. Beta-blocker use in decompensated heart failure. Despite the current advances in treatment, acute decompensated heart failure s for more than 1 million hospital admissions annually. Many of the patients hospitalized are already receiving long-term treatment with beta-blockers.
For patients who receive full dose beta-blocker therapy and suffer acute decompensated heart failure, clinicians face two key questions: what to do, if anything, with the dosage of beta-blocker and what is the best way to integrate inotropic and beta-blocker therapies for patients who require inotropes.
This article discusses these issues and reviews the available literature. Because these topics have received little systematic evaluation, we also present our clinical approaches to these problems. In heart failure the chronic sympathetic stimulation alters the cardiac beta-adrenergic pathway.
This alteration le to a diminished contractile response to stimulation of the cardiac beta 1 receptor. A blockade of the beta 1 receptor partly restores the physiologic response to sympathetic stimulation at rest and during exercise. Several mechanisms resulting from the competitive blockade of the beta 1 receptor may be important.
Patients with heart failure who are treated with a beta-blocker experience initially a slight decrease of the left ventricular function. The starting dose of the beta-blocker has to be very small, e.
In a stepwise fashion the dose has to be increased to a full beta blocking effect over a period of weeks. The two main reasons for withdrawal of the beta-blocker are deterioration of heart failure or symptomatic hypotension.
Symptomatic improvement and a ificant increase of exercise capacity appear gradually and can be measured only after more than 1 month duration of therapy. Three multicenter studies MDC. The MDC trial demonstrated a slower progression of heart failure with Metoprolol. The larger trial with carvedilol was the first study to demonstrate a decreased mortality in patients who initially tolerate the beta-blocker therapy.
Beta-blockers for the treatment of problematic hemangiomas. The subset of patients treated with oral beta-blockers was further characterized, investigating indication for treatment, response to treatment, time to resolution of indication, duration of treatment, occurrence of rebound growth and side effects of therapy. Forty-five patients completed beta-blocker treatment while the remainder continue to receive therapy. Indications for treatment were either functional concerns Functional concerns included ulceration The median age at beta-blocker initiation was 3.
Ninety-nine patients Rebound growth requiring an additional course of therapy was observed in 23 patients. Side effects from beta-blockers included cool extremities Side effects did not result in complete discontinuation of beta-blocker treatment in any case; however, they prompted a switch to a different beta-blocker.
Beta-blocker therapy for tremor in Parkinson's disease.
The tremor of Parkinson's disease can cause considerable disability for the individual concerned. Traditional antiparkinsonian therapies such as levodopa have only a minor effect on tremor. Beta-blockers are used to attenuate other forms of tremor such as Essential Tremor or the tremor associated with anxiety.
It is thought that beta-blockers may be of use in controlling the tremor of Parkinson's disease. To compare the efficacy and safety of adjuvant beta-blocker therapy against placebo for the treatment of tremor in patients with Parkinson's disease. Grey literature was hand searched and the reference lists of identified studies and reviews examined. The manufacturers of beta-blockers were contacted.
Randomised controlled trials of adjuvant beta-blocker therapy versus placebo in patients with a clinical diagnosis of idiopathic Parkinson's disease. Data was abstracted independently by two of the authors onto standardised forms and disagreements were resolved by discussion. Four randomised controlled trials were found comparing beta-blocker therapy with placebo in patients with idiopathic Parkinson's disease. These were double-blind cross-over studies involving a total of 72 patients. Three studies did not present data from the first arm, instead presenting as combined data from both treatment arms and both placebo arms.
The risk of a carry-over effect into the second arm meant that these were not analysed. The fourth study presented data from each arm. This was in the form of a mean total score for tremor for each group. Details of the baseline scores, the s of patients in each group and standard deviations were not. Formulary considerations in selection of beta-blockers.
Selection of beta-adrenergic blockers for formulary addition can be a difficult task, especially with the increasing availability of new beta-blockersas well as the numerous differences in pharmacodynamic and pharmacokinetic properties of currently available agents. Nevertheless, appropriate evaluation of the important characteristics of beta-blockers should allow selection of the most cost-effective agents for formulary addition.
Most importantly, differences in efficacy, product formulation and cost should be carefully considered when making formulary decisions. Notably, evidence from clinical trials indicates differences in efficacy among beta-blockers for post-myocardial infarction prophylaxis, situational anxiety, essential tremor, thyrotoxicosis, migraine prophylaxis and prevention of bleeding associated with oesophageal varices.
For many clinical situations, it is also important to select an effective agent that is available in both an oral and intravenous formulation, especially for cardioprotection after acute myocardial infarction and for use in supraventricular arrhythmias. In addition, availability of sustained release products and generic formulations should be considered for their potential to increase compliance and decrease cost, respectively.
Comparative drug costs, as well as costs associated with decreased compliance, should also be carefully evaluated.