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当代心脏病学中的β受体阻滞剂:摒弃它们会更好吗?

Beta Blockers in Contemporary Cardiology: Is It Better to Cast Them Out?

作者信息

Dar Javaid Ahmad, Jacob John Roshan

机构信息

Department of Cardiology, Christian Medical College, Vellore, India.

出版信息

Korean Circ J. 2024 Apr;54(4):165-171. doi: 10.4070/kcj.2023.0209.

Abstract

Beta blockers are one of the commonest prescription drugs in medicine and they have been thought to revolutionize the treatment of heart failure (HF) with reduced ejection fraction (HFrEF) in the last century. In addition to HFrEF, they are prescribed for a variety of diseases in cardiology from hypertension to HF, angina, and stable coronary artery disease (CAD). The increased prescription of beta blockers in conditions like HF with preserved ejection fraction (HFpEF), and stable CAD may be doing more harm than good as per the data we have so far. The available data shows that beta blockers are associated with increased stroke risk and atrial fibrillation (AF) in hypertension and in patients with HFpEF, they have been associated with decreased exercise capacity. In patients with stable CAD and patients with myocardial infarction with normal systolic functions, beta blockers don't offer any mortality benefit. In this article, we critically review the common indications and the uses of beta blockers in patients with HFpEF, CAD, hypertension and AF and we propose that beta blockers are over-prescribed under the shadow of their beneficial effects in patients with HFrEF.

摘要

β受体阻滞剂是医学上最常用的处方药之一,在上个世纪,人们认为它们彻底改变了射血分数降低的心力衰竭(HFrEF)的治疗方法。除了HFrEF,它们还被用于治疗心脏病学中的多种疾病,从高血压到心力衰竭、心绞痛和稳定型冠状动脉疾病(CAD)。根据我们目前掌握的数据,在射血分数保留的心力衰竭(HFpEF)和稳定型CAD等情况下增加β受体阻滞剂的处方可能弊大于利。现有数据表明,β受体阻滞剂与高血压患者中风风险增加和心房颤动(AF)有关,在HFpEF患者中,它们与运动能力下降有关。在稳定型CAD患者和收缩功能正常的心肌梗死患者中,β受体阻滞剂没有任何降低死亡率的益处。在本文中,我们批判性地回顾了β受体阻滞剂在HFpEF、CAD、高血压和AF患者中的常见适应症和用途,并提出在HFrEF患者有益作用的阴影下,β受体阻滞剂被过度处方了。

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