在患有HFmrEF或HFpEF的患者中,β-阻断剂的当代使用和影响:The DELIVER试验
Alexander Peikert1, Bradley A Bart2, Muthiah Vaduganathan1
1Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
JACC. Heart failure
|September 28, 2023
概括
贝塔阻塞剂的使用在心力衰竭中常见,其中保留喷射分数 (HFpEF) 和心力衰竭中轻微减少喷射分数 (HFmrEF),并且不会增加不良结果. 达帕格利弗洛辛在这些患者中有效且安全地减少了心血管事件,无论是否使用β-阻断剂.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 贝塔阻塞剂经常被处方用于心力衰竭的并发症,并保留喷射分数 (HFpEF),尽管在HFpEF治疗中没有指导方针推.
- 人们担心贝塔抑制剂对HFpEF患者慢性反应和临床结果的潜在不良影响.
研究的目的:
- 为了研究诊断为HFpEF或HFmrEF的患者中β-阻断剂的当前使用模式.
- 在 DELIVER 试验的背景下,评估贝塔抑制剂治疗在该患者群体中的临床影响和安全性.
主要方法:
- 分析了来自Deliver试验的数据,该试验随机将6263名LVEF>40%的患者分配给达帕格利弗洛辛或安慰剂.
- 一个预先规定的分析检查了基于在随机化时使用β抑制剂的疗效和安全结果.
- 主要终点被定义为心血管死亡或心力衰竭恶化的复合结果.
主要成果:
- 83%的参与者使用β-阻断剂,处方率的区域差异很大.
- 在调整后的分析中,β阻塞剂的使用与主要结局 (心血管死亡或心血管疾病恶化) 的风险降低有关.
- 达帕格利弗洛辛在降低贝塔抑制剂使用者和非使用者的主要结果方面表现出一致的有效性,没有显著的相互作用效应. 在各组中,安全概况是相似的.
结论:
- 在DELIVER试验中,大多数患有HFmrEF或HFpEF的患者接受了β-阻断剂治疗.
- 在这个队列中,β-阻断剂治疗与心血管不良事件风险增加或心力衰竭恶化无关.
- 达帕格利弗洛辛为患有HFmrEF/HFpEF的患者提供了一致和安全的临床益处,不管他们的背景β-阻断剂治疗情况如何.
相关概念视频
01:22Heart Failure Drugs: β-Blockers
357
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
357
01:27Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers
881
β-receptor blockers significantly impact the cardiovascular system by counteracting catecholamine-induced sympathetic responses. These medications decrease heart rate, contractility, and cardiac output, potentially leading to cardiac depression, life-threatening bradycardia, and death. Therapeutically, β-blockers function as mild antihypertensives and are utilized in treating angina pectoris and cardiac arrhythmias. However, nonselective β-blockers inhibit β2-receptors in...
881
01:28Antihypertensive Drugs: Types of β-Blockers
723
β receptors are classified into three subclasses: β1, β2, and β3. β1 receptors are primarily located in the heart and kidneys. When they get activated, they increase heart rate, contractility, and renin release. This process enhances blood pressure and aids in stress management. In contrast, β2 receptors are situated mainly in the lungs, blood vessels, and skeletal muscles. Upon activation, they trigger smooth muscle relaxation, causing bronchodilation and...
723
01:30Heart Failure V: Medical Management
12
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
12
01:25Adrenergic Antagonists: Chemistry and Classification of β-Receptor Blockers
652
β-adrenergic antagonists, or β-blockers, modulate the sympathetic nervous system by targeting β-adrenoceptors and inhibiting catecholamine-mediated sympathetic responses. β-blockers differ in their adrenoceptor subtype affinity, lipophilicity, and α-blocking capabilities. The history of β-blocker development began with the prototype, dichloroisoprenaline, which exhibited partial agonist activity. As a result, propranolol was developed as a pure antagonist but...
652
01:31Adrenergic Antagonists: ɑ and β-Receptor Blockers
507
Third-generation β-blockers, such as labetalol and carvedilol, represent a significant advancement in managing cardiovascular conditions. Unlike conventional β-blockers, which can induce peripheral vasoconstriction, third-generation drugs block α1 adrenoceptors. This promotes vasodilation through several mechanisms, such as increased nitric oxide production, inhibition of calcium ion entry, opening of potassium ion channels, and antioxidant action. Labetalol, for instance, is...
507