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Heart Failure Drugs: β-Blockers01:22

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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,...
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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...
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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...
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Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which...
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Angina pectoris, a primary symptom of ischemic heart disease, requires careful pharmacological interventions. In this context, calcium channel blockers (CCBs) and ranolazine have emerged as crucial pharmacotherapeutic agents, providing deep insights into the complexities of angina management.
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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...
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在心肌梗塞后的β-阻断剂中断或延续

Johanne Silvain1, Guillaume Cayla1, Emile Ferrari1

  • 1From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France.

The New England journal of medicine
|August 30, 2024
PubMed
概括

在心肌梗塞后停止β阻塞剂治疗并未证明与继续治疗相比不劣. 这项研究表明,对于有史无并发性心肌梗塞的患者,应维持长期β-阻断剂治疗.

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科学领域:

  • 心脏病学 心脏病学
  • 临床试验 临床试验
  • 药理学 药理学是指药理学的学科.

背景情况:

  • 心肌梗塞后β-阻断剂治疗的最佳持续时间尚不清楚.
  • 需要评估暂停长期β阻断剂治疗的安全性和有效性,以减轻副作用并改善无并发性心肌梗塞后患者的生活质量.

研究的目的:

  • 为了确定是否暂停长期β-阻塞剂治疗是不劣于继续它在患者有史无并发性心肌梗塞.
  • 评估β抑制剂中断对患者生活质量的影响.

主要方法:

  • 一个多中心的,开放的,随机的,非劣等性试验,涉及3698名患者.
  • 患有心肌梗塞病史和左心室喷射率≥40%的患者被随机分配到中断或继续接受β阻塞剂治疗.
  • 主要终点是死亡,非致命的心肌梗塞,中风或心血管住院的综合结果,非劣势率为<3个百分点.

主要成果:

  • 暂停β-阻断剂治疗并没有被发现与继续治疗相比没有劣势. 主要结局事件发生率在中断组为23.8%,在延续组为21.1%.
  • 风险差异为2.8个百分点 (95% CI,<0.1至5.5),危险比为1.16 (95% CI,1.01至1.33).
  • 停用β-阻断剂并没有证明患者的生活质量有所改善.

结论:

  • 在心肌梗塞后暂停长期β-阻塞剂治疗并非不劣于继续治疗.
  • 这些发现表明,继续接受β-阻断剂治疗对于有史无并发性心肌梗塞的患者来说是一个更合适的策略.
  • 可能需要进一步的研究来探索在这种患者群体中管理长期β抑制剂治疗的替代策略.