Atherosclerosis and beta-blockade: A forgotten option?

Czech version

Authors: Michal Vrablík; Eva Tůmová
Authors‘ workplace: Centrum preventivní kardiologie, III. interní klinika – endokrinologie a metabolismu 1. LF UK a VFN v Praze
Published in: Vnitř Lék 2019; 65(12): 795-801
Category:

Overview

Beta-blockers have been ranked fourth in management recommendations for arterial hypertension in the management of arterial hypertension. This “retreat” is justified by the results of studies comparing different antihypertensive strategies that documented a lesser benefit of the beta-blockers tested compared to control therapies. Obviously, even within the beta-adrenergic receptor blocking group, there are important differences between agents. Properties such as selectivity to receptors and their subtypes, hydrophilicity and resp. lipophilicity, control of blood pressure, influence of intermediate metabolism or directly influence on vascular reactivity determine the resulting potential benefit associated with therapy. The results of clinical trials are also influenced by the test population and concomitant medications. There are a number of studies documenting the benefit of beta-blockers in patients with a history of atherothrombotic events or in the context of heart failure. In the context of the treatment of (yet) uncomplicated hypertension, we are interested not only in the main effects – lowering blood pressure, but also in other potentially effects significant for the resulting effect and influencing the prognosis (favorable or undesirable). In the case of beta-blockers, the effect on atherosclerosis development, lipidogram, vascular wall quality, anti-inflammatory effects, etc. In beta-blockers, several studies have suggested that their metabolic side-effect profile is so unfavorable that they need insulin resistance in patients with dyslipidemia, diabetes or obesity always avoid. This article returns to the question of the metabolic properties of beta-blockers and their possible direct antiatherogenic action and thus the site that this drug class should have in the field of cardiovascular prevention.

Keywords:

Atherosclerosis – beta-blockers – cardiovascular prevention – diabetes mellitus – dyslipidemia

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