Safety and tolerability of β-blockers: importance of cardioselectivity
Hans‐Peter Marti, Abel Alberto Pavía López, Pedro Vellosa Schwartzmann
Abstract
Cardioselective b-blockade is generally well tolerated in practice and contraindications to this therapy are uncommon.b-blockers are a diverse therapeutic class, and their individual tolerability profiles are influenced strongly by their pharmacodynamic effects across different adrenergic receptors.Bisoprolol, probably the b-blocker with the highest selectivity for blockade of b 1 -vs.b 2 -adrenoceptors, does not block b 2 -adrenoceptors to an appreciable extent at doses in therapeutic use.Side-effects often attributed to b-blockers, such as erectile dysfunction and adverse metabolic effects are uncommon with bisoprolol and other b-blockers used at doses which only block b 1 -adrenoceptors.Cautious use of a cardioselective b-blocker is not contraindicated in people with chronic obstructive pulmonary disease or asthma and the outcomes benefits of b-blockers in patients with coronary heart disease or heart failure are also apparent in patients with concurrent COPD.Starting with a low dose and titrating upwards carefully is important for optimising the tolerability of a b-blocker.Most people with hypertension will receive combination antihypertensive therapy in practice, and the low-dose combination therapy approach provides a useful strategy for optimising the efficacy and tolerability of a regimen that includes a b-blocker, compared with up-titrating an existing monotherapy.