Cardioprotection with beta-blockers: myths, facts and Pascal's wager.
Beta-blockers were documented to reduce reinfarction rate more than 3 decades ago and subsequently touted as being cardioprotective for a broad spectrum of cardiovascular indications such as hypertension, diabetes, angina, atrial fibrillation as well as perioperatively in patients undergoing surgery. However, despite lowering blood pressure, beta-blockers have never shown to reduce morbidity and mortality in uncomplicated hypertension. Also, beta-blockers do not prevent heart failure in hypertension any better than any other antihypertensive drug class. Beta-blockers have been shown to increase the risk on new onset diabetes. When compared with nondiuretic antihypertensive drugs, beta-blockers increase all-cause mortality by 8% and stroke by 30% in patients with new onset diabetes. Beta-blockers are useful for rate control in patients with chronic atrial fibrillation but do not help restore sinus rhythm or have antifibrillatory effects in the atria. Beta-blockers provide symptomatic relief in patients with chronic stable angina but do not reduce the risk of myocardial infarction. Adverse effects of beta-blockers are common including fatigue, dizziness, depression and sexual dysfunction. However, beta-blockers remain a cornerstone in the management of patients having suffered a myocardial infarction and for patients with heart failure. Thus, recent evidence argues against universal cardioprotective properties of beta-blockers but attest to their usefulness for specific cardiovascular indications.
Messerli
F H
FH
Division of Cardiology, St Luke's and Roosevelt Hospitals, Columbia University College of Physicians & Surgeons, New York, NY 10019, USA. messerli.f@gmail.com
Bangalore
S
S
Yao
S S
SS
Steinberg
J S
JS
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000188:drug therapy / Q000401:mortality
D000319:Adrenergic beta-Antagonists