Heart failure, chronic beta-blockers

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. 

Ahmed A, Dell Italia LJ. Use of beta-blockers in older adults with chronic heart failure. Am J Med Sci. 2004 328 100-111. 

Beta-adrenoceptor blockers. The realisation that the coiuse of chronic heart failure can be adversely affected by activation of the renin-angiotensin-aldosterone and sympathetic nervous systems led to exploration of possible benefit from P-adrenoceptors in a condition where, paradoxically, such drugs can have an adverse effect. Clinical trials have, indeed, shown that bisoprolol, carvedilol or metoprolol lower mortality and decrease hospitalisation when added to diuretics, digoxin and an ACE inhibitor (see below). 

Kodama K, Kuwahara T, et al. Effect of beta-blocker on left ventricular function and natriuretic peptides in patients with chronic heart failure treated with angiotensin-converting enzyme inhibitor. Jpn Circ J 2000 64 365-9. 

Bristow MR, Murphy GA, Krause-Steinrauf H et al (2010) An alpha2C-adrenergic receptor polymorphism alters the norepinephrinelowering effects and therapeutic response of the beta-blocker bucindolol in chronic heart failure. Circ Heart Fail 3 21-28... 

In symptomatic chronic heart failure, beta-blockers are also an essential component of an optimal medical regimen, as demonstrated in several trials (95-98). Currently extended-release metoprolol succinate, carve-dilol, and bisoprolol remain the agents of choice for treatment of patients with chronic ischemic heart disease and NYHA Class II-IV symptomatic heart failure. 

Gottlieb SS Are all beta-blockers the same for chronic heart failure Curr Cardiol Rep 3(2) 124-129,... 

D. Beta-Adrenoceptor Antagonists Several beta blockers (carvedilol, labetalol, metoprolol) have been shown in long-term studies to reduce progression of chronic heart failure. This benefit of p-blockers had long been recognized in patients with hypertrophic cardiomyopathy but has now been shown to also occur in patients without cardiomyopathy. Beta-blockers are not of value in acute failure and may be detrimental if systolic dysfunction is marked. 

Smith, A.J. Wehner, J.S. Manley, FI.J. Richardson, A.D. Beal, J. Bryant, P.J. Current role of beta-adrenergic blockers in the treatment of chronic congestive heart failure. Am. J. Flealth. Syst. Pharm. 2001, 58, 140-145. 

Respiratory Possible unwanted effects of carvedilol, metoprolol, and bisoprolol on respiratory function in patients with heart failure and concomitant chronic obstructive pulmonary disease (COPD) have not been clearly defined. In a randomized, open, triple-crossover trial, 51 patients with heart failure, 35 of whom had also COPD, took carvedilol, metoprolol, and bisoprolol, dose-matched, each for 6 weeks before resuming their original beta-blocker. N-terminal brain natriuretic peptide (BNP)... 

Jabbour A, Macdonald PS, Keogh AM, Kotlyar E, Mellemkjaer S, Coleman CF, Elsik M, Krum H, Hayward CS. Differences between beta-blockers in patients with chronic heart failure and chronic obstructive pulmonary disease a randomized crossover trial. J Am Coll Cardiol 2010 55 1780-8. 

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