Cardiovascular Protection Using Beta-BlockersA Critical Review of the Evidence
Sripal Bangalore, MD, MHA*,
Franz H. Messerli, MD*,1,*,
John B. Kostis, MD ,2 and
Carl J. Pepine, MD ,3
* St. Luke’s-Roosevelt Hospital and Columbia University, New York, New York
University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
University of Florida College of Medicine, Gainesville, Florida.
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Figure 1 Number Needed to Treat in Major Randomized Controlled Trials of Beta-Blockers for Heart Failure
Treatment of 15 to 43 patients with heart failure prevents 1 death and, thus, beta-blockers are very effective in patients with heart failure. CAPRICORN = CArvedilol Post infaRction SurvIval COntRol in left ventricular dysfunctioN; CIBIS = Cardiac Insufficiency Bisoprolol Study; COPERNICUS = CarvedilOl ProspEctive RaNdomIzed CUmulative Survival Trial; MERIT-HF = MEtoprolol CR/XL Randomized Intervention Trial in chronic Heart Failure.
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Figure 2 Overview of Major Meta-Analyses of Randomized Controlled Trials of Beta-Blockers in Patients With Heart Failure
In patients with heart failure, beta-blockers are efficacious agents for the prevention of cardiovascular events. ACEi = angiotensin-converting enzyme inhibitors; ARBs = angiotensin receptor blockers; BB = beta-blocker; CI = confidence interval; HR = hazard ratio; LVEF = left ventricular ejection fraction; NYHA = New York Heart Association.
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Figure 3 Proposed Use of Beta-Blockers for Hypertension
In patients with uncomplicated hypertension, beta-blockers should not be used as first-line agents. However, in patients with uncontrolled hypertension on various other antihypertensive agents and in those with complicated hypertension, beta-blockers should be considered in the armamentarium of treatment. CHF = chronic heart failure; MI = myocardial infarction.
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