title: [Present trends and controversies in the use of beta-blockers in cardiovascular diseases].
abstract: In this paper we summarize present trends and controversies in the use of beta-blockers in cardiovascular diseases. Beta-blockers are catecolamine competitive inhibitors and act through alpha and beta adrenergic receptors blockade. Different agents have a dose-dependent affinity for different beta adrenergic receptors (beta 1, beta 2, beta 3) which is less with higher doses. The most important therapeutic effects of beta-blockers are on cardiovascular system, where they act as negative chronotropic and inotropic agents, lowering cardiac work and improving oxygen demand /supply ratio. Clinical indications are numerous. For their anti-ischemic activity beta-blockers are used as anti-anginal drugs and in acute and previous myocardial infarction for preventing total and cardiovascular mortality. Combined use of beta-blockers and ACE inhibitors slows down heart failure progression and reduces cardiovascular mortality. Beta-blockers are useful in treating focal atrial tachycardia and supra ventricular paroxysmal tachycardia, by reducing sinus node automaticity and delay atrio-ventricular conduction; they also prevent sudden cardiac death and ventricular tachycardia associated with increased sympathetic activity. There is no indication in treating primary non-complicated hypertension with beta-blockers as first-line drugs. Different metabolic effects of selective and non-selective beta-blockers are actually debated. In conclusion, beta-blockers have indication in the treatment of many cardiovascular diseases. Further studies are needed for better understanding the differences in cardiac and peripheral beta-blockers effects depending on their selectivity.
authors.affiliation: Unità Insufficienza Cardiaca, Dipartimento di Scienze cardiovascolari, Istituto Scientifico San Raffaele, Milano.
authors.forename: Roberto
authors.initials: R
authors.lastname: Spoladore
authors.forename: Gabriele
authors.initials: G
authors.lastname: Fragasso
authors.forename: Claudia
authors.initials: C
authors.lastname: Montanaro
authors.forename: Francesco
authors.initials: F
authors.lastname: Maranta
authors.forename: Camilla
authors.initials: C
authors.lastname: Torlasco
authors.forename: Stefano
authors.initials: S
authors.lastname: Gerosa
authors.forename: Alberto
authors.initials: A
authors.lastname: Margonato
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D017202:Myocardial Ischemia / Q000188:drug therapy
chemical_list: D000319:Adrenergic beta-Antagonists