Controversies accumulated around betablockers

Czech version

Authors: Jaromír Hradec
Authors‘ workplace: III. interní klinika 1. LF UK a VFN Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA
Published in: Vnitř Lék 2015; 61(5): 410-416
Category: Reviews

Overview

Betablockers are one of the most successful drug classes in cardiology. They have many indications – starting with treatment of arterial hypertension, continuing with secondary prevention post myocardial infarction up to the treatment of heart failure with reduced ejection fraction. Recently, many analysis and information were published which are questioning yet unshakable role of betablockers in some cardiovascular diagnosis. This review article summarizes the controversies, which have accumulated around betablockers in the treatment of hypertension, secondary prevention of coronary artery disease, perioperative administration in patients undegoing non-cardiac surgery and treatment of heart failure with reduced ejection fraction. Some of these controversies already led to guidelines modifications, other will probably lead to guidelines changes in near future.

Key words:
arterial hypertension – betablockers – heart failure – perioperative care – secondary prevention

Sources

1. Ahlquist RP. A study of the adrenotropic receptors. Am J Physiol 1948; 153(3): 586–600.

2. The Norvegian Multicenter Study Group. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 1981; 304(14): 801–807.

3. McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33(14): 1787–1847. Erratum in Eur Heart J. 2013; 34(2): 158.

4. Hradec J, Vítovec J, Špinar J. Souhrn doporučených postupů ESC pro diagnostiku a léčbu akutního a chronického srdečního selhání – 2012. Připraven Českou kardiologickou společností. Cor Vasa 2013; 55(01): 33–48.

5. Hradec J, Bultas J, Želízko M Stabilní angina pectoris. Doporučený diagnostický a léčebný postup České kardiologické společnosti. Cor Vasa 2010; 52(09): 543–561.

6. Filipovský J, Widimský J jr, Špinar J. Souhrn Doporučení Evropské společnosti pro hypertenzi/Evropské kardiologické společnosti pro diagnostiku a léčbu hypertenze z roku 2013. Připraven Českou společností pro hypertenzi/Českou kardiologickou společností. Cor Vasa 2014; 56(06): 646–667.

7. Lindholm LH, Carlberg B, Samuelsson O. Should beta-blockers remain first choice in the treatment of arterial hypertension? A meta-analysis. Lancet 2005; 366(9496): 1545–1553.

8. Opie LH. Beta-blockade should not be among several choices for initial therapy of hypertension. J Hypertension 2008; 26(2): 161–163.

9. Messerli FH, Bangalore R, Julius S. Risk/benefit assessment of beta-blockers and diuretics precludes their use for first-line therapy in hypertension. Circulation 2008; 117(20): 2706–2715.

10. UK National Institute for Health and Clinical Excellence and British Hypertension Society. Hypertension: management of hypertension in adults in primary care. 2006. NICE guidelines [CG34]. Dostupné z WWW: <http://www.nice.org.uk/CG034>.

11. Carlberg B, Samuelson O, Lindholm LH. Atenolol in hypertension: is it a wise choice? Lancet 2004; 364(9446): 1684–1689.

12. Khan N, McAlister FA. Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis. CMAJ 2006; 174(12): 1737–1742.

13. Turnbull F, Niel B, Ninomiya T et al. Pressure Lowering Treatment Trialists’ Collaboration. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. Blood BMJ 2008; 336(7653): 1121–1123.

14. Bangalore S, Makani H, Radford M et al. Clinical outcomes with β-blockers for myocardial infarction: a metanalysis od randomized trials. Am J Med 2014; 127(10): 939–953.

15. Widimský P, Kala P, Rokyta R. Souhrn Doporučených postupů ESC pro diagnostiku a léčbu pacientů s akutním infarktem myokardu s elevacemi úseků ST z roku 2012. Připraven Českou kardiologickou společností. Cor Vasa 2012; 54(9–10): 447–463.

16. Puymirat E. Can beta-blocker be stopped in patients with preserved left ventricular function after acute myocardial infarction? Five-year follow-up of FAST-MI. European Society of Cardiology Congress 2014; August 31, 2014. Barcelona, Spain.

17. Bangalore S, Steg PG, Deedwania P et al. β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA 2012; 308(13): 1340–1349.

18. Bangalore S, Bhatt DL, Steg PG et al. β-Blockers and Cardiovascular Events in Patients With and Without Myocardial Infarction. Post Hoc Analysis From the CHARISMA Trial. Circ Cardiovasc Qual Outcomes 2014; 7(6): 872–881. Dostupné z DOI: <http://dx.doi.org/10.1161/circoutcomes.114.001073>.

19. Devereaux PJ, Yang H, Yusuf S et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomized controlled trial. Lancet 2008; 371(9627): 1839–1847.

20. Ozasa N, Morimoto T, Bao B et al. CREDO-Kyoto Registry Investigators. β-blocker use in patients after percutaneous coronary interventions: one size fits all? Worse outcomes in patients without myocardial infarction or heart failure. Int J Cardiol 2013; 168(2): 774–779.

21. Brinkman W, Herbert MA, O’Brien S et al. Preoperative β-blocker use in coronary artery bypass grafting surgery: national database analysis. JAMA Intern Med 2014; 174(8): 1328–1329.

22. Poldermans D, Bax JJ, Boersma E et al. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery; European Society of Cardiology (ESC). Eur Heart J 2009; 30(22): 2769–2812.

23. Poldermans D, Boersma E, Bax JJ et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 1999; 341(24): 1789–1794.

24. Bouri S, Shun-Shin MJ, Cole GD et al. Meta-analysis of secure randomized control trials of β-blockade to prevent perioperative death in non-cardiac surgery. Heart 2013; 100(6): 456–464.

25. Hawkes N. Use of β blockers during surgery may have caused 10,000 deaths in the UK. BMJ 2013; 347: f4914. Dostupné z DOI: <http://dx.doi.org/10.1136/bmj.f4914>.

26. Kristensen SD, Knuuti J, Saraste A et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 2014; 35(35): 2383–2431.

27. Flather MD, Shibata MS, Coats AJS et al. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 2005; 26(3): 215–225.

28. Bhatia V, Bajaj NS, Sanam K et al. Beta-blocker use and 30-day all-cause readmission in Medicare beneficiaries with systolic heart failure. Am J Med 2014; pii: S0002–9343(14)01218–2. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjmed.2014.11.036>.

29. Kotecha, D, Holmes J, Krum H et al. Efficacy of beta-blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet 2014; 384(9961): 2235–2243.