Beta-blocker therapy has been noti...

Beta-blocker therapy has been notion to be contraindicated in patients with systolic dysfunction heart failure. However, modern studies have shown that beta-blocker therapy in these patients may contract mortality and decrease hospitalizations. Although this benefit has been shown in multiple studies, affairs still exist about the adverse events beta-blocker therapy may have in patients with heart failure, including worsening of heart failure, hypotension, dizziness, bradycardia, and fatigue. These touchs may deter some physicians from prescribing beta blocker for these patients. The various studies in succession beta-blocker therapy in patients with heart failure have reported adverse tenors from this class of medications, unless none have established estimated risks for these adverse efficiencys Ko and associates performed an overview of randomized clinical trials of beta blocker in patients with heart failure to quantify adverse consequences of this therapy.

The thought was an overview of randomized trials of beta-blocker therapy in patients with heart failure. Trials included in the review had to confront the following inclusion criteria: random al location of treatments, non-crossover design, placebo manage at least 100 participants in each treatment clump and a minimum of six month of follow-up Of the 148 articles identified, nine met the inclusion criteria. A random-effects design was used to combine the comes of the nine studies.

Beta-blocker therapy was ground to increase the absolute annual risk of hypotension in 11 for 1,000 patients, dizziness in 57 through 1,000 patients, and bradycardia in 38 for 1,000 patients. The relative risk for these adverse consequences was 1.41 for hypotension, 137 for dizziness, and 362 for bradycardia. All of these risks were significantly increased compared with placebo. There was no significant increase in the absolute risk for fatigue. Positive aspects of beta-blocker therapy included a reduction in all-cause mortality in 34 through 1,000 patients, a reduction in heart failure hospitalizations in 40 for 1,000 patients, and a reduction in worsening of heart failure in 52 by 1,000 patients. The overall withdrawal rate was 16 percent for beta-blocker therapy and 18 percent for placebo.

The authors bring to an end that although beta-blocker therapy is associated wit h more [i]or[/i] less adverse effects, the increase in the absolute risk for these efficiencys is small. They note that fewer patients withdrew from beta-blocker therapy than from placebo. This consideration should reduce concerns about prescribing beta-blocker therapy in patients with heart failure.

KARL E MILLER, MD

Ko DT et al. Adverse tenors of [beta]-blocker therapy for patients with heart failure. A quantitative overview of randomized trials. Arch Intern M July 12 2004;164:1389-94

EDITOR 'S NOTE: Despite beta-blocker therapy being shown to form morbidity and mortality in patients with heart failure, physicians still fear using this class of medication in these patients. In an accompanying editorial, (1) Chatterjee argues that it is time to forget these fears. The actual contraindications for beta-blocker therapy in patients with heart failure include morose bronchospasms, hypotension, severe bradycardia, and heart stiffen Even patients with chronic obstructive pulmonary disease and diabetes have been shown to benefit from beta-blocker therapy. a certain quantity of of the concerns about these put drugs intos can be eased by starting at lower dosages and titrating slowly Using this strategy, physicians can use beta blocker safely in patients with heart failure.--K.E.M.

REFERENCE

(1) Chatterjee K The fear of [beta]-blocker therapy in heart failure: time to forget [Editorial]. Arch Intern M 2004;164:1370-1

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