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Beta-Blockers

The Cornerstone of Cardiac Drug Therapy
Part of the Contemporary Cardiology book series (CONCARD)

Abstract

This chapter tells you
  • Which beta-blocker is best for your patients.

  • The pharmacodynamic reasons why atenolol is a relatively ineffective beta-blocker and why the use of atenolol should be curtailed.

  • More about the important indication for heart failure (HF), New York Heart Association (NYHA) class II-III and now compensated class IV, and for all with left ventricular (LV) dysfunction regardless of functional class; thus, in class I patients with an ejection fraction (EF) < 40% and in those with myocardial infarction (MI) with HF or LV dysfunction without HF, beta-blockers are recommended at the same level as angiotensin-converting enzyme (ACE) inhibitors.

  • Why beta-blockers should be recommended for diabetic patients with hypertension with or without proteinuria and for diabetic patients with coronary heart disease (CHD). From about 1990 to 2002, most internists proclaimed in editorials and to trainees that these agents were a poor choice in this setting.

  • More recently, their use as initial agents for the treatment of primary hypertension has been criticized, particularly for diabetics with hypertension; do beta-blocking drugs cause diabetes or is the condition observed, simply, benign glucose intolerance in some? (See  Chapter 2, Beta-Blocker Controversies.)

  • Why is it incorrect to say that beta-blockers are not advisable for hypertensive patients over age 65, as many teachers, textbooks, and editorials state. This was reiterated in an editorial by Cruickshank entitled “Beta-blockers continue to surprise us” (1).

  • The results of randomized clinical trials (RCTs) that prove the lifesaving properties of these agents.

  • All their indications.

  • Salient points that relate to each beta-blocker and show the subtle and important differences confirming that beta-blockers are not all alike. Beta-blockade holds the key, but lipophilic versus hydrophilic features may be important, and brain concentration may enhance cardioprotection.

Keywords

Heart Rate Variability Calcium Antagonist Essential Tremor Coronary Heart Disease Event Rate Pressure Product 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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  1. Cominacini L, Fratta Pasini A, Garbin U, et al. Nebivolol and its 4-keto derivative increase nitric oxide in endothelial cells by reducing its oxidative inactivation. J Am Coll Cardiol 2003;42:1838–1844.PubMedCrossRefGoogle Scholar
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