β-Blockade for Patients with Hypertension, Ischemic Heart Disease or Heart Failure: Where are We Now?

Abstract

β-blockers are a heterogeneous class of drugs, with varying selectivity/specificity for β₁ vs β₂ receptors, intrinsic sympathomimetic activity (ISA), and vasodilatory properties (through β₂ stimulation, α receptor blockade or nitric oxide release). These drugs are indicated for the management of arterial hypertension, heart failure or ischemic heart disease (IHD; eg angina pectoris or prior myocardial infarction). Most of the benefit of β-blockade in these conditions arises from blockade of the β₁ receptor, and, in practice, the addition of ISA appears to reduce the potential for improved clinical outcomes in people with heart failure or IHD. Aspects of the benefit/risk balance of β-blockers remain controversial, and recent meta-analyses have shed new light on this issue. We have reviewed the current place of cardioselective β-blockade in hypertension, IHD and heart failure, with special reference to the therapeutic profile of a highly selective β₁-adrenoceptor blocker, bisoprolol.

Keywords:

• beta blockade
• hypertension
• congestive heart failure
• ischemic heart disease
• bisoprolol

Acknowledgments

A medical writer (Dr Mike Gwilt, GT Communications) funded by Merck Serono Middle East FZ-LLC) provided editorial assistance in the development of the manuscript. The authors retained full control over the content of the manuscript.

Disclosure

AP reports personal fees, non-financial andsupport for attendiance at international congresses from Merck Serono Middle East FZ-LLC, Menarini, and Bouchara-Recordati SAS. SM is an employee of Merck Serono Middle East FZ-LLC, an affiliate of Merck KGaA, Germany. The authors report no other conflicts of interest in this work.