Pharmacological and clinical aspects of drug therapy in coronary heart disease: clinical aspects of therapy with beta-adrenoceptor antagonists
Prichard, B.N.
Zeitschrift für Kardiologie 79(Suppl 3): 99-103
1990
ISSN/ISBN: 0300-5860 PMID: 1983055 Document Number: 361328
Beta-adrenergic blocking drugs reduce myocardial oxygen consumption, chiefly by reducing heart rate as the principal basis for their efficacy in ischaemic heart disease. Regardless of the presence of associated properties, beta, selectivity, partial agonist activity, all beta-blocking drugs have been found efficacious in the treatment of angina pectoris, both alone and in combination with drugs such as nitrates and calcium antagonists. Holter monitoring has demonstrated beta blockers also reduce the incidence of silent ischaemia. Finally, they are established in the treatment of acute infarction and secondary prevention of recurrences. There are inherent disadvantages of inhibition of the beta sympathetic, most notably the precipitation of asthma and heart failure in susceptible subjects. Recently, combined-action beta-blocking drugs have been developed, i.e. combining beta blockade with peripheral vasodilator activity, either by alpha 1, blockade, beta 2 stimulation or a direct effect independent of either receptor. They have a more favourable haemodynamic profile and, while initial studies are promising, it is not yet clear whether this will be translated into improved clinical benefit in ischaemic heart disease.