β-Blockers

阿替洛尔 医学 卡维地洛 奈比洛尔 美托洛尔 血压 酒石酸美托洛尔 药效学 药理学 安慰剂 胰岛素抵抗 普萘洛尔 冠状动脉疾病 内科学 药代动力学 心脏病学 心力衰竭 胰岛素 替代医学 病理
作者
Toni L. Ripley,Joseph J. Saseen
出处
期刊:Annals of Pharmacotherapy [SAGE Publishing]
卷期号:48 (6): 723-733 被引量:76
标识
DOI:10.1177/1060028013519591
摘要

Objective: To review the pharmacology, pharmacokinetics, and pharmacodynamic properties of commonly used β-blockers (atenolol, carvedilol, metoprolol succinate, metoprolol tartrate, and nebivolol). Data Sources: A MEDLINE literature search (1966-May 2013) was performed using the following key terms: hypertension, β-blockers, atenolol, carvedilol, metoprolol tartrate, metoprolol succinate, nebivolol, pharmacology, pharmacodynamics, pharmacokinetics, blood pressure, metabolic, lipid, central aortic pressure, diabetes, and insulin resistance. References from publications reviewed were included. Study Selection and Data Extraction: English-language articles identified were reviewed. Animal studies and studies in patients for a primary diagnosis of coronary artery disease were excluded. Data Synthesis: β-Blockers are no longer recommended first-line therapy for primary hypertension, based on data showing that β-blockers are inferior to other antihypertensives and no better than placebo, in spite of provision of blood pressure reduction. Because atenolol is the β-blocker used in 75% of these studies, uncertainty about widespread application to all β-blockers exists. Different pharmacological and physiological properties, both within β-blockers and compared with other antihypertensives, may explain divergent effects. Evidence shows that β-blockers have a truncated effect on central aortic pressure, an independent predictor of cardiovascular events, compared with other antihypertensive classes; differences within the class may exist, but the evidence is inconclusive. Metabolic effects differ within the β-blocker class, with evidence that carvedilol causes less metabolic dysregulation. Conclusion: Emerging evidence reveals physiological differences within the β-blocker class and in comparison to other antihypertensives. These differences provide insight into the diverse clinical effects β-blockers provide in cardiovascular disease.
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