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Around the beta-blockers, one more time.

T T Sproat1, L M Lopez

  • 1Department of Pharmacy Practice, College of Pharmacy, University of Florida, Gainesville 32610.

DICP : the Annals of Pharmacotherapy
|September 1, 1991
PubMed
Summary
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This review discusses beta-blockers, detailing their pharmacology, pharmacokinetics, and uses for cardiovascular conditions like hypertension and myocardial infarction (MI). It aims to guide clinicians in selecting appropriate beta-adrenergic blocking agents for patient care.

Area of Science:

  • Pharmacology and Therapeutics
  • Cardiovascular Medicine

Background:

  • Beta-blockers are crucial in managing cardiovascular diseases, including hypertension, ischemic heart disease, arrhythmias, and myocardial infarction (MI) prophylaxis.
  • These drugs function by antagonizing catecholamines at beta-adrenoreceptors, influencing cardiac output and blood pressure.

Purpose of the Study:

  • To provide a comprehensive review of beta-blocker pharmacology, pharmacokinetics, and cost.
  • To assist clinicians in making informed decisions regarding beta-blocker selection for hospital formularies and individual patients.

Main Methods:

  • Review of existing literature on beta-blocker properties, indications, and therapeutic controversies.
  • Analysis of ancillary properties such as intrinsic sympathomimetic activity (ISA), cardioselectivity, and membrane stabilizing activity.

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  • Examination of pharmacokinetic variations including duration of action, elimination routes, and lipophilicity.

    • Main Results:

    • Beta-blockers reduce myocardial oxygen demand via negative inotropic and chronotropic effects, lower blood pressure, and possess antiarrhythmic properties.
    • Different beta-blockers exhibit varied central nervous system (CNS) penetration, potentially causing adverse CNS effects.
    • Effects on renal blood flow and pulmonary function (bronchodilation) vary, with some nonselective agents potentially worsening bronchospastic disease. Interactions with glucose metabolism (hypoglycemia/hyperglycemia) and controversial effects on total peripheral resistance (TPR) are noted.

    Conclusions:

    • Beta-blockers are effective and equally efficacious for hypertension, arrhythmias, and ischemic heart disease.
    • Understanding the diverse properties and potential adverse effects of beta-blockers is essential for optimal clinical application.
    • Further research into the controversial effects on total peripheral resistance and specific patient populations is warranted.