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Current role of β-adrenergic blockers in the treatment of chronic congestive heart failure
- Source :
- American Journal of Health-System Pharmacy. 58:140-145
- Publication Year :
- 2001
- Publisher :
- Oxford University Press (OUP), 2001.
-
Abstract
- Recent findings on the use of beta-adrenergic blockers in patients with congestive heart failure (CHF) are reviewed. CHF is a progressive, debilitating disease that afflicts 4.6 million patients in the United States. Treatment has traditionally consisted of a diuretic, an angiotensin-converting-enzyme (ACE) inhibitor, and digoxin. Despite advances in ACE-inhibitor therapy, the five-year mortality rate remains nearly 50%. Overstimulation of the sympathetic nervous system is believed to contribute to mortality. Beta-blockers have recently been added to the standard of care for patients with New York Heart Association functional class II or III heart failure. Four randomized, double-blind, placebo-controlled clinical trials were recently completed that addressed the benefits of beta-blockers in CHF. The overall mortality rate was reduced 65% by carvedilol, 34% by metoprolol, and 33% by bisoprolol; all these reductions were significant compared with placebo, and the trials were ended early. Bucindolol, however, did not have a significant effect on mortality. These drugs are hepatically metabolized and may require dosage adjustment in hepatically impaired patients. Decompensation of heart failure is another consideration; a beta-blocker should be added only for patients with stable CHF. Dosages must be slowly adjusted to targeted levels. Adverse effects do not differ significantly among beta-blockers. In addition to their effect on mortality, beta-blockers reduce CHF-related morbidity, such as all-cause hospitalization. Carvedilol, metoprolol, and bisoprolol decrease the mortality and morbidity associated with CHF and can be used with limited adverse effects. The choice among these agents does not affect clinical outcomes; bucindolol, however, has proven ineffective.
- Subjects :
- medicine.medical_specialty
Digoxin
Heart disease
Drug Compounding
chemistry.chemical_compound
Internal medicine
Medicine
Adverse effect
Legislation, Pharmacy
Carvedilol
Metoprolol
Pharmacology
United States Food and Drug Administration
business.industry
Health Policy
Bucindolol
medicine.disease
United States
chemistry
Bisoprolol
Anesthesia
Heart failure
Cardiology
Radiopharmaceuticals
business
Tomography, Emission-Computed
medicine.drug
Subjects
Details
- ISSN :
- 15352900 and 10792082
- Volume :
- 58
- Database :
- OpenAIRE
- Journal :
- American Journal of Health-System Pharmacy
- Accession number :
- edsair.doi.dedup.....3b21d4e88b4bbe4064aca4a8b30c9525
- Full Text :
- https://doi.org/10.1093/ajhp/58.2.140