Eichhorn E J
Cardiac Catheterization Laboratory, Dallas Veterans Administration Hospital, Texas.
Am J Med. 1992 May;92(5):527-38. doi: 10.1016/0002-9343(92)90750-6.
To review the current data regarding the use of beta-adrenergic blockers for the treatment of congestive heart failure.
Relevant studies published between 1975 and 1991 were reviewed. Key data from each study were extracted. The significance of conclusions reached by each author(s) was identified.
beta-adrenergic blockade, although still considered an investigational therapy for the treatment of congestive heart failure, has been proven in several studies to improve ventricular function, including myocardial contractility and relaxation. In addition, since beta-blockade up-regulates myocardial beta-receptors, the myocardium becomes more responsive to graded doses of beta-agonists. Speculation regarding the possible mechanisms of these effects is presented. In addition, since beta-blockers have been shown to reduce neurohormonal activation, they may have a beneficial effect on survival. Although small pilot studies or subgroup analysis of larger studies suggest beta-blockade therapy improves survival in heart failure, this has yet to be proven. Large prospective trials are warranted to study this issue.
As current data suggest, beta-blockers improve ventricular function and reduce neurohormonal activation in heart failure. beta-blockers should be considered as adjunctive therapy in patients with congestive heart failure. In addition, future studies are warranted to better elucidate their effects on ventricular function and survival.
回顾目前有关使用β-肾上腺素能阻滞剂治疗充血性心力衰竭的数据。
回顾了1975年至1991年间发表的相关研究。提取了每项研究的关键数据。确定了每位作者得出结论的重要性。
β-肾上腺素能阻滞剂尽管仍被视为治疗充血性心力衰竭的试验性疗法，但在多项研究中已被证明可改善心室功能，包括心肌收缩力和舒张功能。此外，由于β-阻滞剂可上调心肌β受体，心肌对分级剂量的β激动剂反应性增强。文中对这些效应的可能机制进行了推测。此外，由于β-阻滞剂已被证明可减少神经激素激活，它们可能对生存率有有益影响。尽管小型试点研究或大型研究的亚组分析表明β-阻滞剂疗法可改善心力衰竭患者的生存率，但这一点尚未得到证实。有必要进行大型前瞻性试验来研究这个问题。
正如目前的数据所示，β-阻滞剂可改善心力衰竭患者的心室功能并减少神经激素激活。β-阻滞剂应被视为充血性心力衰竭患者的辅助治疗药物。此外，有必要进行进一步研究以更好地阐明它们对心室功能和生存率的影响。
