转为高血压第一线治疗的β抑制剂
Franz H Messerli1, Sripal Bangalore2, John M Mandrola3
1Faculty of Medicine, University of Bern, Bern, Switzerland.
Lancet (London, England)
|October 16, 2023
概括
最近的指导方针建议升级β抑制剂治疗高血压. 然而,证据表明它们在预防中风和心血管死亡方面效果不如其他一线药物,这引发了对患者安全的担忧.
科学领域:
- 心脏病学
- 药理学
- 高血压管理
背景情况:
- 欧洲高血压协会的指导方针现在将β抑制剂与其他一线抗高血压药物一起使用.
- 这种提升归因于高血压与贝塔抑制剂治疗的其他疾病的共同发生.
- 这种理性包括一种"双重"方法,用一种药物治疗多种疾病.
研究的目的:
- 在高血压指南中评估支持β抑制剂升级地位的证据.
- 评估贝塔抑制剂与其他一线抗高血压药物的比较疗效.
- 解决关于指导方针变化对患者结果,特别是中风预防的潜在影响的问题.
主要方法:
- 审查目前的国家和国际高血压指南.
- 综合证据分析,比较β阻断剂与酸性利尿剂,氨酸阻断剂和通道阻断剂的有效性.
- 评估支持重新分类β抑制剂的新证据.
主要成果:
- 在预防中风和心血管死亡方面,比其他一线抗高血压药物更不有效.
- 现有证据不支持将β阻断剂转换为第一线治疗.
- 之前的指导方针将β抑制剂降为替代品的地位是基于强有力的综合证据.
结论:
- 最近欧洲高血压学会的指导方针中对β抑制剂的升级没有证据支持其更高的疗效.
- 人们担心这一指导方针的变化可能会造成广泛的伤害,因为β阻塞剂提供较低的中风保护.
- 在高血压治疗中,β- 阻断剂应保留替代性地位,仅用于其益处超过风险的特定适应症.
相关概念视频
Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers
867
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...
867
Adrenergic Antagonists: Chemistry and Classification of β-Receptor Blockers
634
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...
634
Hypertension IV: Drug Therapy and Lifestyle Modifications
12
Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...
12
Antihypertensive Drugs: Types of β-Blockers
708
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...
708
Heart Failure Drugs: β-Blockers
346
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,...
346
Antihypertensive Drugs: Action of β1 Blockers
456
β1-receptors are primarily located in the heart and kidneys. In cardiac myocytes, these receptors interact with neurotransmitters released by the sympathetic nervous system during heightened activity or danger. As a result, β1-receptors get activated, initiating a series of biochemical processes. Excessive activation of beta receptors due to chronic stress can abnormally increase heart rate and contractility, resulting in high blood pressure or hypertension. To counteract this,...
456


