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Beta-blockers, dyslipidemia, and coronary artery disease. A reassessment
1Georgetown University Medical Center, Washington, DC.
Insights
Beta-blockers offer modest protection against heart attacks in hypertension patients. Non-sympathomimetic beta-blockers may reduce cardiac complications, but metabolic effects lack clinical outcome data.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Management
Background:
- Hypertension accelerates atherosclerosis, increasing cardiovascular risk.
- Beta-blockers are known to benefit patients with coronary artery disease.
- Antihypertensive trials show limited protection from beta-blockers against myocardial infarction.
Purpose of the Study:
- To explore reasons for the limited efficacy of beta-blockers in preventing myocardial infarction.
- To examine the clinical relevance of beta-blockers' metabolic effects.
- To assess the role of beta-blockers in hypertensive patients with coronary artery disease.
Main Methods:
- Review of existing antihypertensive trials involving beta-blockers.
- Analysis of studies on the metabolic effects (lipids, glucose) of beta-blockers.
- Evaluation of evidence regarding beta-blockers with and without intrinsic sympathomimetic activity.
Main Results:
- Beta-blockers provide only modest protection against fatal and nonfatal myocardial infarction.
- Long-term use of non-sympathomimetic beta-blockers may reduce cardiac complications in hypertension.
- No quantified clinical outcome data exists for lipid and glucose changes from beta-blocker therapy.
Conclusions:
- The metabolic effects of beta-blockers vary and may have limited clinical relevance.
- Appropriate beta-blockers should be considered for hypertension in patients with coronary artery disease or high risk.
- Further research is needed to fully understand beta-blocker mechanisms and optimize their use.
Abstract:
Despite the strong association between hypertension and accelerated atherosclerosis, and the known beneficial clinical effects of beta-blockers in patients with coronary artery disease, antihypertensive trials of beta-blockers have shown only modest protection against fatal and nonfatal myocardial infarction. This review explores the explanations put forth for this apparent failure of beta-blockers. It also examines the clinical relevance of the metabolic effects of beta-blockers within the framework of the heterogeneity of this class of drugs. Recent evidence indicates that long-term treatment of hypertension with beta-blockers that do not possess intrinsic sympathomimetic activity reduces the occurrence of cardiac complications of hypertension. There are no data to show a quantified effect on clinical outcome of the lipid and glucose changes associated with beta-blocker therapy. The metabolic influence of these drugs varies considerably within the class and may be of little clinical relevance. Unless it is contraindicated, an appropriate beta-blocker should be considered for the treatment of hypertension in patients who have coronary artery disease or who are at high risk for coronary artery disease.