title: Differential effect of β-blockers for heart rate control in coronary artery disease.
abstract: BACKGROUND
  Resting heart rate is an independent risk factor for cardiovascular disease and is mainly controlled by β-blockers (BBs). BBs are part of the optimal medical treatment for coronary artery disease (CAD), and their benefit correlates with resting heart rate (RHR) reduction.
  
  
  OBJECTIVE
  RHR is poorly controlled in daily practice among patients with stable cardiovascular disease, and control is only achieved by some BBs.
  
  
  METHODS
  Observational, cross-sectional, and multicenter study of CAD patients recruited nationwide from 20 institutions. Antecedents, risk factors, and treatments were collected. Controlled RHR was considered at <70 bpm.
  
  
  RESULTS
  The mean age of the 2897 patients included was 67.4 years (11.4%), and 75.9% were males. Patients treated with a BB (56.5%) had a lower mean age and comorbidities. The mean RHR was 69.6 bpm (12.6). A significantly lower RHR was observed in patients treated with a BB compared to the rest (67.2 vs 73.0 bpm; P<0.01), and no difference was observed in patients treated with a calciumchannel blocker (CCB). The analysis by individual agents identified that only patients treated with atenolol, bisoprolol, and metoprolol had significantly lower RHR than those not receiving a BB. No differences were observed in mean doses of each agent according to RHR control, except for verapamil. BB treatment was independently associated with RHR control (odds ratio [OR]: 2.42, 95% CI: 2.05-2.87; P<0.01), and no association was found for nondihydropyridine CCBs (OR: 0.99, 95% CI: 0.96-1.02; P = 0.38). Bisoprolol (OR: 1.56, 95% CI: 1.38-1.78; P<0.01), atenolol (OR: 2.01, 95% CI: 1.57-3.49; P<0.01), and metoprolol (OR: 1.29, 95% CI: 1.04-1618; P = 0.04) were independently associated with RHR control.
  
  
  CONCLUSIONS
  RHR is poorly controlled in CAD patients, and although BBs are the most efficient therapy, in daily clinical practice RHR <70 bpm is only independently associated with atenolol, bisoprolol, or metoprolol.
authors.affiliation: Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain. acorderofort@gmail.com
authors.forename: Alberto
authors.initials: A
authors.lastname: Cordero
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-González
authors.forename: Pilar
authors.initials: P
authors.lastname: Mazón
authors.forename: José
authors.initials: J
authors.lastname: Moreno-Arribas
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fácila
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.forename: Jose R
authors.initials: JR
authors.lastname: González-Juanatey
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-Martínez
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology* / Q000627:therapeutic use; D000368:Aged; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male
chemical_list: D000319:Adrenergic beta-Antagonists
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