Skip to main content

Advertisement

SpringerLink
Log in

Beta-blocker contraindications: Are there patients or situations where use is inappropriate?

  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

β-blockers have been conclusively proven to increase survival and improve symptoms of heart failure, yet there is underutilization of these agents most commonly because of misunderstandings of the relative contraindications and adverse events during treatment. In this manuscript, we discuss the potential contraindications to β-blockers in heart failure and compare the true risks against the significant benefits.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Sirak TE, Jelic S, Le Jemtel TH: Therapeutic update: nonselective beta-and alpha-adrenergic blockade in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure. J Am Coll Cardiol 2004, 44:497–502.

    Article  PubMed  CAS  Google Scholar 

  2. Salpeter S, Ormiston T, Salpeter E: Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2005, 4:CD003566.

    PubMed  Google Scholar 

  3. Salpeter SR, Ormiston TM, Salpeter EE: Cardioselective beta-blockers in patients with reactive airway disease: a meta-analysis. Ann Intern Med 2002, 137:715–725.

    PubMed  CAS  Google Scholar 

  4. Kotlyar E, Keogh AM, Macdonald PS, et al.: Tolerability of carvedilol in patients with heart failure and concomitant chronic obstructive pulmonary disease or asthma. J Heart Lung Transplant 2002, 21:1290–1295.

    Article  PubMed  Google Scholar 

  5. Haas SJ, Vos T, Gilbert RE, Krum H: Are beta-blockers as efficacious in patients with diabetes mellitus as in patients without diabetes mellitus who have chronic heart failure? A meta-analysis of large-scale clinical trials. Am Heart J 2003, 146:848–853.

    Article  PubMed  CAS  Google Scholar 

  6. Torp-Pedersen C, Metra M, Charlesworth A, et al.: Effects of metoprolol and carvedilol on preexisting and new on-set diabetes in patients with chronic heart failure {inverted exclamation}V data from the Carvedilol or metoprolol European Trial (COMET). Heart 2007, [Epub ahead of print].

  7. Ubbink DT, Verhaar EE, Lie HK, Legemate DA: Effect of beta-blockers on peripheral skin microcirculation in hypertension and peripheral vascular disease. J Vasc Surg 2003, 38:535–540.

    Article  PubMed  Google Scholar 

  8. Hiatt WR, Stoll S, Nies AS: Effect of beta-adrenergic blockers on the peripheral circulation in patients with peripheral vascular disease. Circulation 1985, 72:1226–1231.

    PubMed  CAS  Google Scholar 

  9. Pasternack PF, Grossi EA, Baumann FG, et al.: Beta blockade to decrease silent myocardial ischemia during peripheral vascular surgery. Am J Surg 1989, 158:113–116.

    Article  PubMed  CAS  Google Scholar 

  10. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group. BMJ 1998, 317:713–720.

  11. Feringa HH, van Waning VH, Bax JJ, et al.: Cardioprotective medication is associated with improved survival in patients with peripheral arterial disease. J Am Coll Cardiol 2006, 47:1182–1187.

    Article  PubMed  Google Scholar 

  12. Mangoni AA, Jackson SH: The implications of a growing evidence base for drug use in elderly patients. Part 3. Beta-adrenoceptor blockers in heart failure and thrombolytics in acute myocardial infarction. Br J Clin Pharmacol 2006, 61:513–520.

    Article  PubMed  CAS  Google Scholar 

  13. Ahmed A: Myocardial beta-1 adrenoceptor down-regulation in aging and heart failure: implications for beta-blocker use in older adults with heart failure. Eur J Heart Fail 2003, 5:709–715.

    Article  PubMed  CAS  Google Scholar 

  14. Krum H, Hill J, Fruhwald F, et al.: Tolerability of beta-blockers in elderly patients with chronic heart failure: the COLA II study. Eur J Heart Fail 2006, 8:302–307.

    Article  PubMed  CAS  Google Scholar 

  15. Hjalmarson A, Goldstein S, Fagerberg B, et al.: Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group. JAMA 2000, 283:1295–1302.

    Article  PubMed  CAS  Google Scholar 

  16. Packer M, Coats AJ, Fowler MB, et al.: Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001, 344:1651–1658.

    Article  PubMed  CAS  Google Scholar 

  17. Deedwania PC, Gottlieb S, Ghali JK, et al.: Efficacy, safety and tolerability of beta-adrenergic blockade with metoprolol CR/XL in elderly patients with heart failure. Eur Heart J 2004, 25:1300–1309.

    Article  PubMed  CAS  Google Scholar 

  18. Flather MD, Shibata MC, Coats AJ, 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, 26:215–225.

    Article  PubMed  CAS  Google Scholar 

  19. Beta-blocker Evaluation of Survival Trial Investigators: A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. N Engl J Med 2001, 344:1659–1667.

    Article  Google Scholar 

  20. Freudenberger R, Kalman J, Mannino M, et al.: Effect of race in the response to metoprolol in patients with congestive heart failure secondary to idiopathic dilated or ischemic cardiomyopathy. Am J Cardiol 1997, 80:1372–1374.

    Article  PubMed  CAS  Google Scholar 

  21. Yancy CW, Fowler MB, Colucci WS, et al.: Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure. N Engl J Med 2001, 344:1358–1365.

    Article  PubMed  CAS  Google Scholar 

  22. Goldstein S, Deedwania P, Gottlieb S, et al.: Metoprolol CR/XL in black patients with heart failure (from the Metoprolol CR/XL randomized intervention trial in chronic heart failure). Am J Cardiol 2003, 92:478–480.

    Article  PubMed  CAS  Google Scholar 

  23. Simon T, Mary-Krause M, Funck-Brentano C, Jaillon P: Sex differences in the prognosis of congestive heart failure: results from the Cardiac Insufficiency Bisoprolol Study (CIBIS II). Circulation 2001, 103:375–380.

    PubMed  CAS  Google Scholar 

  24. Ghali JK, Pina IL, Gottlieb SS, et al.: Metoprolol CR/XL in female patients with heart failure: analysis of the experience in Metoprolol Extended-Release Randomized Intervention Trial in Heart Failure (MERIT-HF). Circulation 2002, 105:1585–1591.

    Article  PubMed  CAS  Google Scholar 

  25. Ghali JK, Krause-Steinrauf HJ, Adams KF, et al.: Gender differences in advanced heart failure: insights from the BEST study. J Am Coll Cardiol 2003, 42:2128–2134.

    Article  PubMed  Google Scholar 

  26. Shekelle PG, Rich MW, Morton SC, et al.: Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status: a meta-analysis of major clinical trials. J Am Coll Cardiol 2003, 41:529–538.

    Article  Google Scholar 

  27. Kukin ML, Kalman J, Mannino MM, et al.: Beta blockade in congestive heart failure: persistent adverse haemodynamic effects during chronic treatment with subsequent doses. Heart 1997, 78:444–449.

    PubMed  CAS  Google Scholar 

  28. Gattis WA, O’Connor CM, Gallup DS, et al.: Predischarge initiation of carvedilol in patients hospitalized for decompensated heart failure: results of the Initiation Management Predischarge: Process for Assessment of Carvedilol Therapy in Heart Failure (IMPACT-HF) trial. J Am Coll Cardiol 2004, 43:1534–1541.

    Article  PubMed  CAS  Google Scholar 

  29. Gattis WA, O’Connor CM, Leimberger JD, et al.: Clinical outcomes in patients on beta-blocker therapy admitted with worsening chronic heart failure. Am J Cardiol 2003, 91:169–174.

    Article  PubMed  CAS  Google Scholar 

  30. Butler J, Young JB, Abraham WT, et al.: Beta-blocker use and outcomes among hospitalized heart failure patients. J Am Coll Cardiol 2006, 47:2462–2469.

    Article  PubMed  CAS  Google Scholar 

  31. Ko DT, Hebert PR, Coffey CS, et al.: Adverse effects of beta-blocker therapy for patients with heart failure: a quantitative overview of randomized trials. Arch Intern Med 2004, 164:1389–1394.

    Article  PubMed  CAS  Google Scholar 

  32. Nagatsu M, Spinale FG, Koide M, et al.: Bradycardia and the role of beta-blockade in the amelioration of left ventricular dysfunction. Circulation 2000, 101:653–659.

    PubMed  CAS  Google Scholar 

  33. Packer M, Bristow MR, Cohn JN, et al.: The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. US Carvedilol Heart Failure Study Group. N Engl J Med 1996, 334:1349–1355.

    Article  PubMed  CAS  Google Scholar 

  34. Stecker EC, Fendrick AM, Knight BP, Aaronson KD: Prophylactic pacemaker use to allow beta-blocker therapy in patients with chronic heart failure with bradycardia. Am Heart J 2006, 151:820–828.

    Article  PubMed  Google Scholar 

  35. Wilkoff BL, Cook JR, Epstein AE, et al.: Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002, 288:3115–3123.

    Article  PubMed  Google Scholar 

  36. Sweeney MO, Hellkamp AS, Ellenbogen KA, et al.: Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003, 107:2932–2937.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 125 Paterson Street, New Brunswick, NJ, 08901, USA

    Ronald S. Freudenberger MD

Authors
  1. S. D. Naik PharmD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ronald S. Freudenberger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ronald S. Freudenberger MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Naik, S.D., Freudenberger, R.S. Beta-blocker contraindications: Are there patients or situations where use is inappropriate?. Curr Heart Fail Rep 4, 93–98 (2007). https://doi.org/10.1007/s11897-007-0006-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-007-0006-5

Keywords

Search

Navigation