Xue Ruicong, Liu Chen, Yu Qian, Dong Yugang, Zhao Jingjing
Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
NHC Key Laboratory of Assisted Circulation and Vascular Diseases (Sun Yat-Sen University), Guangzhou, Guangdong, China.
Am J Cardiovasc Drugs. 2025 Apr 19. doi: 10.1007/s40256-025-00732-1.
β-blockers are a fundamental component of cardiovascular disease (CVD) management, while β-agonists are used to treat chronic obstructive pulmonary disease (COPD). Current guidelines recommend that these conditions be treated as usual, even when they coexist. However, there have been concerns over COPD exacerbation risk with β-blockers and attenuation of the beneficial effects of β-agonists in this comorbid population, leading to β-blocker underuse. Recent evidence suggests that β-blockers, particularly cardioselective β-blockers, do not increase COPD exacerbations, demonstrate good efficacy and safety, and improve survival in patients with COPD after first-time myocardial infarction. In atrial fibrillation with COPD, both cardioselective and nonselective β-blockers may be associated with a lower COPD exacerbation risk than calcium channel blockers, as well as improving outcomes and reducing mortality risk. In this review, we summarize the β-blocker prescribing patterns in patients with CVD and COPD; describe the reasons for β-blocker underuse in patients with CVD with COPD; collate up-to-date evidence on the effects of β-blockers on symptoms and outcomes in each of these comorbid populations; and review the current treatment guidelines for coexisting COPD and CVD to support the rational prescribing of β-blockers. Finally, we provide recommendations for future research needed to demonstrate the clinical rationale of prescribing β-blockers and to encourage the generation of more robust evidence-based guidelines for β-blockers use. Future large-scale, prospective, randomized controlled trials are needed to expand the body of evidence and better understand the effects of β-blockers in CVD with comorbid COPD.
β受体阻滞剂是心血管疾病（CVD）管理的基本组成部分，而β激动剂则用于治疗慢性阻塞性肺疾病（COPD）。当前指南建议，即使这些疾病同时存在，也应按常规进行治疗。然而，人们一直担心β受体阻滞剂会增加COPD急性加重的风险，以及在这种合并症人群中β激动剂的有益作用会减弱，从而导致β受体阻滞剂使用不足。最近的证据表明，β受体阻滞剂，尤其是心脏选择性β受体阻滞剂，不会增加COPD急性加重的风险，具有良好的疗效和安全性，并且在首次心肌梗死后的COPD患者中可提高生存率。在合并COPD的心房颤动患者中，与钙通道阻滞剂相比，心脏选择性和非选择性β受体阻滞剂都可能与较低的COPD急性加重风险相关，同时还能改善预后并降低死亡风险。在本综述中，我们总结了CVD和COPD患者中β受体阻滞剂的处方模式；描述了合并COPD的CVD患者中β受体阻滞剂使用不足的原因；整理了关于β受体阻滞剂对这些合并症人群中症状和预后影响的最新证据；并回顾了当前COPD和CVD并存的治疗指南，以支持β受体阻滞剂的合理处方。最后，我们为未来的研究提供建议，以证明开具β受体阻滞剂的临床依据，并鼓励制定更有力的基于证据的β受体阻滞剂使用指南。未来需要进行大规模、前瞻性、随机对照试验，以扩大证据范围，并更好地了解β受体阻滞剂在合并COPD的CVD中的作用。
