β-Blockade for Patients with Hypertension, Ischemic Heart Disease or Heart Failure: Where are We Now?
Atul Pathak, Sanaa Mrabeti
Abstract
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. Keywords: beta blockade, hypertension, congestive heart failure, ischemic heart disease, bisoprolol