Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; National Heart and Lung Institute, Imperial College, London, United Kingdom.
J Am Coll Cardiol. 2019 Aug 6;74(5):672-682. doi: 10.1016/j.jacc.2019.04.067.
As new treatments continue to improve clinical outcomes in coronary artery disease (CAD) and heart failure, it is necessary to characterize the appropriate use of β-adrenergic receptor blockers (β-blockers) in the contemporary management of these conditions. This review examines the current evidence supporting β-blocker use in heart failure with preserved ejection fraction (HFpEF), heart failure with midrange ejection fraction (HFmEF), and heart failure with reduced ejection fraction (HFrEF), following acute coronary syndrome and in stable CAD. β-Blockers remain essential in the treatment of HFrEF, but limited evidence supports their use in HFmEF or HFpEF. They should still be considered routinely following acute coronary syndrome, but there is a need for contemporary trials that re-examine this in patients without left ventricular dysfunction, as well as in patients with stable CAD. From a global perspective, more studies are needed to characterize the extent of β-blocker use in CAD and heart failure, and how evidence-based use can be improved in these conditions.
随着新的治疗方法不断改善冠心病 (CAD) 和心力衰竭的临床疗效，有必要对β-肾上腺素能受体阻滞剂 (β 受体阻滞剂) 在这些疾病的当代治疗中的合理应用进行评估。本综述检查了目前支持β受体阻滞剂在射血分数保留的心力衰竭 (HFpEF)、射血分数中间范围的心力衰竭 (HFmEF) 和射血分数降低的心力衰竭 (HFrEF)、急性冠状动脉综合征后和稳定型 CAD 中的使用的证据。β受体阻滞剂在 HFrEF 的治疗中仍然是必不可少的，但有限的证据支持它们在 HFmEF 或 HFpEF 中的使用。急性冠状动脉综合征后仍应常规考虑使用，但需要进行当代试验，重新评估无左心室功能障碍患者以及稳定型 CAD 患者的应用。从全球角度来看，需要更多的研究来描述 CAD 和心力衰竭中β受体阻滞剂的使用程度，以及如何在这些情况下改善基于证据的使用。
