Heart failure beta-blockers

Liggett, S. B., Mialet-Perez, J., Thaneemit-Chen, S., et al. (2006) A polymorphism within a conserved beta(l)-adrenergic receptor motif alters cardiac function and beta-blocker response in human heart failure. Proc. Natl. Acad. Sci. U. S. A. 103,11288-11293. 

Concurrent administration of beta-blockers, such as atenolol, and calcium-channel blockers may result in an enhanced hypotensive effect caused by an additive effect and heart failure may be precipitated. 

Beta-blockers are medications that reduce the workload of the heart and lower blood pressure. They are commonly prescribed to relieve angina (a type of chest pain, pressure, or discomfort) or treat heart failure. They also are prescribed for people who have high blood pressure (hypertension). Several beta-blockers (metoprolol, propanolol, betaxolol, bisoprolol, and nadolol) have been detected in municipal sewage effluents up to the pg/L level (Temes 1998) and in groundwater samples (Sacher et al. 2001). 

Heart failure-The recommended starting dose is 40 mg twice daily. Up-titrate to 80 and 160 mg twice daily to the highest dose, as tolerated. Consider reducing the dose of concomitant diuretics. The maximum daily dose in clinical trials was 320 mg in divided doses. Concomitant use with an ACE inhibitor and a beta-blocker is not recommended. 

Carteolol (Cartrol/ Ocupress Ophthalmic) [Beta Blocker/ Glaucoma Agent] Uses HTN, T lOP, chronic open-angle glaucoma Action Blocks [3-adrenergic receptors (p, 2)1 ISA Dose Ophth 1 gt in eye(s) bid Caution [C (1st tri) D (2nd 3rd tri), /-] Cardiac failure, asthma Contra Sinus bradycardia heart block >lst-degree bronchospasm Disp Ophth soln SE Drowsiness, sexual dysfxn, bradycardia, edema, CHF, ocular conjunctival... 

In patients with chronic heart failure, the use of digoxin and beta blockers is typically sufficient to control heart rates, and the combination of digoxin with carvedilol has been shown to provide better overall rate control than either of them used alone in heart failure patients [42]. However, if the patient is either intolerant of beta blockers or they fail to... 

Anonymous. A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure, [see comment]. N. Eng. J. Med. 2001 344 1659-67. 

Beta-blockers can no longer be considered as first line monotherapy for uncomplicated hypertension in older patients since some studies suggest they are less effective than diuretics and no better than placebo in reducing cardiovascular outcomes. Their use in elderly with hypertension probably should be confined to those with other indications such as angina, following myocardial infarction or with heart failure. 

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 throm-bolytics in acute myocardial infarction. Br J Chn Pharmacol 2006 61(5) 513-20. 

Beta-blocker AND ACE-I (ARB if ACE-I intolerant). Verapamil if beta-blockers contraindicated. If heart failure, see below... 

Bnnch TJ, Mnhlestein JB, Bair TL, Renlnnd DG, Lappe DL, Jensen KR et al. Effect of beta-blocker therapy on mortality rates and future myocardial infarction rates in patients with coronary artery disease but no history of myocardial infarction or congestive heart failure. Am J Cardiol 2005 95(7) 827-31. 

Brophy JM, Joseph L, Rouleau JL. Beta-blockers in congestive heart failure a Bayesian meta-analysis. Ann Intern Med 2001 134(7) 550-60. 

The most common side effects are Raynaud s phenomenon with cold or even cyanotic distal extremities and digits, tiredness or weakness, bradycardia, and sexual impotence. Less common side effects are depression and dysphoria, bronchoconstriction, congestive heart failure, hallucinations, hypotension, vomiting or nausea, diarrhea, insomnia and nightmares, dizziness, and hypoglycemia. When due attention is paid to contraindications and the treatment is carefully monitored, the side effects of beta-blocker treatment are generally mild. 

Patients should be excluded from beta-blocker treatment if they have significant cardiorespiratory diseases (asthma and other pulmonary obstructive diseases, congestive heart failures, angina), insulin-dependent di-... 

Enalapril maleate is an orally active angiotensin converting enzyme (ACE) inhibitor, it lowers peripheral vascular resistance without causing an increase in heart rate. The maleate salt (enalapril) allows better absorption after oral administration. It is an ideal drug for hypertensive patients who are intolerant to beta-blocker therapy. It also shows promise in the treatment of congestive heart failure. Following oral adminishation, enalapril is rapidly absorbed and hydrolysed to... 

Cleland JG Beta-blockers for heart failure Why, which, when, and where. Med Clin North Am 2003 87 339. [PMID 12693729]... 

Propranolol was the first blocker shown to be effective in hypertension and ischemic heart disease. Propranolol has now been largely replaced by cardioselective blockers such as metoprolol and atenolol. All B-adrenoceptor-blocking agents are useful for lowering blood pressure in mild to moderate hypertension. In severe hypertension, blockers are especially useful in preventing the reflex tachycardia that often results from treatment with direct vasodilators. Beta blockers have been shown to reduce mortality after a myocardial infarction and some also reduce mortality in patients with heart failure they are particularly advantageous for treating hypertension in patients with these conditions (see Chapter 13). 

Bangalore S et al Beta-blockers for primary prevention of heart failure in patients with hypertension Insights from a meta-analysis. J Am Coll Cardiol 2008 52 1062. [PMID 18848139]... 

BETA BLOCKERS THAT HAVE REDUCED MORTALITY IN HEART FAILURE... 

Foody JM, Farrell MH, Krumholtz H Beta blocker therapy in heart failure. JAMA 2002 287 883. [PMID 11851582]... 

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