Hypertension and Beyond: A Glance at the Wide Utility of Beta Blockers
March 22, 2021
BETA-ADRENERGIC BLOCKERS (Beta Blockers) for HEART FAILURE
Mechanism: Interfere with sympathetic nervous system to decreases peripheral vasoconstriction
- Protect heart from over-stimulation by sympathetic nervous system. Blockade of beta receptors antagonizes the increase in sympathetic nervous system activity responsible for the progression of heart failure
- Over a period of 3-6 months BB produce substantial rises in ejection fraction (averaging 10% absolute increase) and reducing LV size and mass
- Current guidelines recommend BB with all patients with stable HF due to LV dysfunction unless unable to tolerate. Patients MUST be stable before treatment is initiated
Beta-Blockers most effective for heart failure
- Carvedilol (Coreg®) target dose: 25mg BID
- Metoprolol succinate (Toprol-XL) target dose 200mg/day
- Bisoprolol (Zebeta®) 10mg daily
Titrate all beta blockers slowly (increase dose every two weeks), but try to get patient to target doses.
BETA-ADRENERGIC BLOCKERS (Beta Blockers) for HYPERTENSION
- Unless a patient has Coronary Artery Disease (CAD), atrial fibrillation, angina or heart failure, beta-blockers are considered second line therapy for hypertension, especially in patients over age 60.
- Atenolol has NOT been shown to improve outcomes in hypertension, heart failure, or after a myocardial infarction.
- Non vasodilating beta blockers are also associated with impaired glucose tolerance, which may lead to an increase risk of new onset Type-2 diabetes. (Carvedilol, labetalol and nebivolol are VASOdilating beta blockers)
BETA-ADRENERGIC BLOCKER (Beta Blocker) for HYPERTENSION IN PREGNANCY
- Labetalol is the preferred antihypertensive in pregnancy. Low concentrations of labetalol appear in breast milk
BETA-ADRENERGIC BLOCKERS (Beta Blockers) for MIGRAINE PROPHYLAXIS
- Metoprolol tartrate (Lopressor), propranolol (Inderal) and timolol (Blocadren) penetrate the blood brain barrier, and have proven efficacy for migraine prevention.
I tell my new heart failure patients that are just starting out on carvedilol (Coreg), that “if I have a miracle drug on my shelf it is carvedilol.”Back in the early 1990’s one of my patients came in with a sheet of paper from his cardiologist. Turns out his cardiologist was Pittsburgh’s most renown heart failure specialist.
He asked me to review the side effects about carvedilol.The drug was not even on the market yet, and the patient was to be enrolled in a study.He was on the heart transplant list, and this was the last-ditch effort using medication.
Have a Great Day on the Bench!!
The patient responded well, lived another 20 years, and never needed a heart transplant.The efficacy of that drug is amazing, just getting the patients to have good adherence is the biggest challenge.Every two weeks when the dose is increased, the patient feels wiped out, and many fall short of the 25mg twice daily goal. Keep encouraging their patients to tolerate the initial side effects, because the benefits are amazing!