Pharmacological and clinical aspects of drug therapy in coronary heart disease: clinical aspects of therapy with beta-adrenoceptor antagonists.
beta-adrenergic blocking drugs reduce myocardial oxygen consumption, chiefly by reducing heart rate as the principal basis for their efficacy in ischaemic heart disease. Regardless of the presence of associated properties, beta, selectivity, partial agonist activity, all beta-blocking drugs have been found efficacious in the treatment of angina pectoris, both alone and in combination with drugs such as nitrates and calcium antagonists. Holter monitoring has demonstrated beta blockers also reduce the incidence of silent ischaemia. Finally, they are established in the treatment of acute infarction and secondary prevention of recurrences. There are inherent disadvantages of inhibition of the beta sympathetic, most notably the precipitation of asthma and heart failure in susceptible subjects. Recently, combined-action beta-blocking drugs have been developed, i.e. combining beta blockade with peripheral vasodilator activity, either by alpha 1, blockade, beta 2 stimulation or a direct effect independent of either receptor. They have a more favourable haemodynamic profile and, while initial studies are promising, it is not yet clear whether this will be translated into improved clinical benefit in ischaemic heart disease.
Prichard
B N
BN
Department of Clinical Pharmacology, University of London, UK.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000818:Animals; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D003327:Coronary Disease / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007741:Labetalol / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000188:drug therapy; D011412:Propanolamines / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D007741:Labetalol