Andrus Miranda R, Loyed Joyce V
Auburn University Harrison School of Pharmacy, Huntsville, Alabama 35801, USA.
Drugs Aging. 2008;25(2):131-44. doi: 10.2165/00002512-200825020-00005.
The incidence of and mortality from both chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) increase with age. In addition, the average age of patients with COPD and CVD is also increasing as a result of improvements in both pharmacological and non-pharmacological treatments. Coronary artery disease is a compelling indication for beta-adrenoceptor antagonist use in a population in whom beta-adrenoceptor antagonism is often viewed as contraindicated. beta-Adrenoceptor antagonists have been proven to improve cardiovascular morbidity and mortality but have been under-utilized in patients with COPD with concomitant CVD because of a fear of bronchoconstriction and adverse effects, particularly in the elderly. The advanced age of patients with COPD and CVD, along with the sheer number of patients with these diseases, necessitates that clinicians understand the treatment of these co-morbidities using seemingly conflicting therapy in the form of beta-adrenoceptor agonists and antagonists. We review changes in the pharmacokinetics and pharmacodynamics of beta-adrenoceptor antagonists in the elderly, the role of beta-adrenoceptor antagonists in CVD and the literature regarding the safety and mortality benefits of beta-adrenoceptor antagonists in elderly patients with COPD and concomitant CVD. We conclude that cardioselective beta-adrenoceptor antagonists appear to be safe to use in elderly male patients with mild-to-moderate COPD who have a compelling indication for beta-adrenoceptor antagonist therapy. Data in female patients are very limited. Nonselective beta-adrenoceptor antagonists should be avoided in general, except in patients with heart failure who might benefit significantly from the use of carvedilol. beta-Adrenoceptor antagonists have been shown to improve mortality in older patients with coexisting CVD and COPD.
慢性阻塞性肺疾病（COPD）和心血管疾病（CVD）的发病率及死亡率均随年龄增长而上升。此外，由于药物治疗和非药物治疗的改善，COPD和CVD患者的平均年龄也在增加。冠状动脉疾病是β-肾上腺素能受体拮抗剂在常被视为禁忌使用β-肾上腺素能受体拮抗剂的人群中使用的一个有力指征。β-肾上腺素能受体拮抗剂已被证明可改善心血管疾病的发病率和死亡率，但由于担心支气管收缩和不良反应，尤其是在老年患者中，在合并CVD的COPD患者中未得到充分利用。COPD和CVD患者的高龄以及这些疾病患者的数量之多，使得临床医生必须了解如何使用看似相互矛盾的β-肾上腺素能激动剂和拮抗剂疗法来治疗这些合并症。我们综述了老年人β-肾上腺素能受体拮抗剂的药代动力学和药效学变化、β-肾上腺素能受体拮抗剂在CVD中的作用以及关于β-肾上腺素能受体拮抗剂在老年COPD合并CVD患者中的安全性和死亡率益处的文献。我们得出结论，对于有β-肾上腺素能受体拮抗剂治疗有力指征的轻度至中度COPD老年男性患者，心脏选择性β-肾上腺素能受体拮抗剂似乎使用安全。女性患者的数据非常有限。一般应避免使用非选择性β-肾上腺素能受体拮抗剂，除非是可能从使用卡维地洛中显著获益的心力衰竭患者。β-肾上腺素能受体拮抗剂已被证明可改善合并CVD和COPD的老年患者的死亡率。
