Kiel Richard G, Deedwania Prakash
a Adult Cardiovascular Disease Fellow, University of California San Francisco - Fresno Medical Education Program - Department of Cardiology , Fresno , CA 93701 , USA.
b Professor of Medicine University of California San Francisco, Director of Heart Failure Services, University of California Fresno - Fresno Medical Education Program - Department of Cardiology , Fresno , CA 93701 , USA.
Expert Opin Drug Saf. 2015;14(12):1855-63. doi: 10.1517/14740338.2015.1102225. Epub 2015 Oct 21.
Beta blockers are one of the cornerstones for treatment of Heart Failure with Reduced Ejection fraction (HFRef), yet their use is often limited by adverse effects, either perceived or real. We performed a review of available data using PubMed.gov utilizing beta blocker, heart failure, reduced ejection fraction and safety as key words.
Several well designed, large scale randomized clinical trials including CIBS-II (bisoprolol), MERIT-HF (metoprolol succinate), and Copernicus (carvedilol) among others, have been conducted in patients with HFRef and demonstrated an improvement in cardiac mortality and morbidity. Despite the preponderance of data supporting the use of beta blockers for patients HFRef, these medications remain underutilized and/or are often prescribed at lower than recommended dosages. Some of the reluctance to embrace beta blockade may be attributed to concern on the part of both the patient and prescriber about the non-cardiac adverse effects of this class of drugs. We have reviewed several recent reviews and meta-analyses of trials of beta blocker in heart failure which have conclusively demonstrated their tolerability in the populations studied.
In the final section of this paper we provide our opinions regarding initiating and optimizing beta blocker therapy for patients with HFRef.
β受体阻滞剂是治疗射血分数降低的心力衰竭（HFRef）的基石之一，但其使用常常受到不良反应的限制，这些不良反应可能是感知到的，也可能是实际存在的。我们利用PubMed.gov，以β受体阻滞剂、心力衰竭、射血分数降低和安全性作为关键词，对现有数据进行了综述。
多项精心设计的大规模随机临床试验，包括CIBS-II（比索洛尔）、MERIT-HF（琥珀酸美托洛尔）和Copernicus（卡维地洛）等，已在HFRef患者中开展，并证明可改善心脏死亡率和发病率。尽管有大量数据支持β受体阻滞剂用于HFRef患者，但这些药物的使用仍未得到充分利用，和/或经常以低于推荐剂量开具处方。部分不愿接受β受体阻滞剂治疗的原因可能是患者和开处方者都担心这类药物的非心脏不良反应。我们回顾了近期几项关于β受体阻滞剂治疗心力衰竭试验的综述和荟萃分析，这些研究已确凿证明了其在所研究人群中的耐受性。
在本文的最后部分，我们给出了关于启动和优化HFRef患者β受体阻滞剂治疗的意见。
