Beta Blockers: From H F Hypertension i to Heart Failure.

Failure
Mohamad Ayman Abdel M i M h dA Abd l Moniem, MD Professor of Cardiology Alexandria University

Development of Antihypertensive Therapies

1940s

1950 Direct Di vasodilators

1957

1960s

1970s -blockers blockers

1980s

1990s

2001

ARBs ARB ACE inhibitors

Peripheral sympatholytics Ganglion blockers Veratrum alkaloids

Thiazides diuretics Central 2 agonists Calcium antagonistsantagonists non DHPs -blockers Calcium antagonistsDHPs

BP Regulation: The Two Key Systems g y y

Sympathetic Nervous System (SNS)

Renin Angiotensin System (RAS)

Mutually i f i M t ll reinforcing actions combine t regulate BP ti bi to l t

Grassi. J Hypertens 2001;19:171316

Classification of Beta Blockers

Classification of Beta Adrenergic receptor blocker

Non Selective N S l ti

Selective S l ti

With alpha blocking activity

Labetalol Carvedilol

Without ISA
Nadolol Propranolol Sotalol Timolol

With ISA

Without ISA
Atenolol Metoprolol Esmolol Bisoprodol

With ISA

Pindolol Penbutolol Oxprenolol p Carteolol

Acebutolol Celiprolol

National British Guidelines (BHS) , BB are 4th ( ) line treatment.

What Guidelines says about the appropriate use of beta blockers ?

JNC VII: Compelling Indications of Individual D I di id l Drug Classes Cl

Compelling indication
Heart Failure

Initial Therapy Options

THIAZ, BB, ACEI,ARB, ALDO ANT

Clinical Trial Basis

ACC/AHA Heart Failure, Guideline,MERIT G id li MERITGuideline,MERITHF,COPERNICUS, CIBIS.SOLVD, AIRE, TRACE, VALHEFT TRACE VALHEFT, RALES ACC/AHA Post MI guideline, id li BHAT,SAVE,Capricorn EPHESUS ALLHAT, HOPE, ANBP2,LIFE CONVINCE

Post Myocardial infarction i f ti

BB, ACEI,
ALDO,ANT

High CAD risk

THIAZ, BB, ACE, CCB

ESC Guidelines for the Diagnosis g and Treatment of Chronic Heart Failure - 2005
Karl S db K l Swedberg
Professor of Medicine Department of Medicine D t t f M di i Sahlgrenska University Hospital/stra Gteborg University Gteborg karl.swedberg@hjl.gu.se
ESC Guidelines for the Diagnosis and Treatment of CHF - 2005 23

BB in CFH:

Contraindicated for 30 ys

2005

2003 1987 2001 1999 1999 1996 1994 1993

ESC Guidelines for the Diagnosis and Treatment of CHF - 2005 34