Review article

Clinical Use of Beta-blockers

Aleksandar Knežević ; Opća bolnica Zadar

Abstract

Beta-blockers started to be more widely used in clinical practice after the introduction of propranolol in 1964. At the beginning, the most used product was propranolol, a non-selective beta-blocker. Later, beta-1 selective blockers atenolol and metoprolol took its place. Over the last ten years, carvedilol, a non-selective beta-blocker with vasodilating properties, and bisoprolol and nebivolol, highly-selective beta-1 blockers, have been used most widely. Nebivolol exerts vasodilating action. However, unlike carvedilol, it exerts its action by releasing nitrogen oxide in the endothelium of blood vessels and not through alpha receptors. Absolute indications (evidence level A) for the administration of beta-blockers include: heart failure, myocardial infarction and arrhythmias (ventricular and post-infarction). Relative indications (evidence level B) are: other arrhythmias, acute coronary syndrome (unstable AP and NSTEMI), STEMI in the acute phase, stable AP and hypertension. Beta-blockers should not be used (evidence level C) as monotherapy in the initial treatment of uncomplicated essential hypertension and in patients with metabolic syndrome. The use of beta-blockers in hypertension is the most controversial, especially if used as monotherapy for uncomplicated essential hypertension. A meta-analysis, whose results showed that the relative risk of CVI was more than 16% higher in patients treated with beta-blockers than in those treated with other antihypertensives, raised controversies regarding their use in hypertension. In the same analysis, the risk of myocardial infarction and total mortality were the same. On the other hand, a number of authors believe that the importance lies in the reduction of blood pressure itself and that these difference are only theoretical and only statistically, and not clinically significant. The authors of European hypertension guidelines (and consequently Croatian guidelines) believe that all basic groups of antihypertensives are equal and differences irrelevant, and that the risk of poor treatment or non-treatment of hypertension is higher than the risk of effects of various antihypertensives. Therefore, beta-blockers, and especially the new ones with vasodilating effects such as carvedilol and nebivolol, remain significant antihypertensive agents.

Keywords

beta-blockers; indications; efficacy; adverse effects

Hrčak ID:

65067

URI

https://hrcak.srce.hr/65067

Publication date:

11.12.2010.

Article data in other languages: croatian

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