Pedersen Michala E, Cockcroft John R
Department of Cardiology, Wales Heart Research Institute, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
Curr Hypertens Rep. 2006 Aug;8(4):279-86. doi: 10.1007/s11906-006-0065-0.
beta-Blockers have generally demonstrated smaller reductions in cardiovascular events, compared with other antihypertensive classes, despite similar reductions in blood pressure. This may be due to the ineffectiveness of traditional beta-blockers, such as atenolol, in reducing central aortic pressure, a strong, independent predictor of cardiovascular outcome. However, the beta-blocker class is heterogeneous, and some newer beta-blockers, which exhibit vasodilatory effects independent of beta-blockade, provide beneficial effects on arterial stiffness and endothelial dysfunction, which may lead to reductions in central aortic pressure and improvements in clinical outcomes. For example, the vasodilating beta-blocker nebivolol was shown to improve forearm blood flow and arterial stiffness and, in a large clinical study, to significantly reduce morbidity and mortality, independent of left ventricular ejection fraction, among patients with chronic heart failure. Further research is warranted to investigate any potential differences between traditional and newer vasodilating beta-blockers on cardiovascular outcomes.
与其他抗高血压药物类别相比，β受体阻滞剂通常在心血管事件方面的降低幅度较小，尽管血压降低幅度相似。这可能是由于传统的β受体阻滞剂，如阿替洛尔，在降低中心主动脉压方面无效，而中心主动脉压是心血管结局的一个强有力的独立预测指标。然而，β受体阻滞剂类别具有异质性，一些表现出独立于β受体阻滞的血管舒张作用的新型β受体阻滞剂，对动脉僵硬度和内皮功能障碍具有有益作用，这可能导致中心主动脉压降低和临床结局改善。例如，血管舒张性β受体阻滞剂奈必洛尔被证明可改善前臂血流和动脉僵硬度，并且在一项大型临床研究中，可显著降低慢性心力衰竭患者的发病率和死亡率，且与左心室射血分数无关。有必要进行进一步研究，以调查传统和新型血管舒张性β受体阻滞剂在心血管结局方面的任何潜在差异。
