ReviewUsefulness of Beta Blockade in Contemporary Management of Patients With Stable Coronary Heart Disease
Section snippets
Historical Perspective
In the United States, CHD accounts for approximately 1/3 of all deaths.4 CAD pathophysiology is related to the adrenergic nervous system, which consists of 2 major receptor types in the adrenergic system (α and β), and was first described in the mid-20th century.5 Alpha receptor activation is associated with contraction of vascular smooth muscle. Beta receptor activation is associated with stimulation of the heart (β1) and relaxation of vascular smooth muscle, bronchi, and uterus (β2).5 Sir
Changes in Stable CHD Management over Time
There has been a dramatic reduction in CHD since the 1960s in the industrialized countries.4, 12 After peaking in 1964 to 1968, at a rate of >200 deaths per 100,000 people, the CHD death rate in the United States has steadily decreased12 to 135 deaths per 100,000 people in 2006 and an age-adjusted rate of 113 per 100,000 population in 2010 (Figure 1).3 CHD mortality has reduced substantially in many European countries, decreasing by >50% between 1980 and 2009.13 A 2007 analysis of CHD suggested
Limitations and side effects of β blockade
Beta blockers have a number of side effects that may limit their role in contemporary management. Discontinuation rates of β blockers may be as high as 25% within the first year and 50% over longer periods of time.21 High discontinuation rates for β blockers are at least partially attributable to these adverse effects that are disagreeable to patients.
Role of β blockade in contemporary management of SCHD
The contemporary role for β blockers has narrowed as we document their limitations, determine their optimal duration of therapy, and develop other effective interventions. Although the most recent guidelines from the United States and Europe still endorse the use of β blockers in a wide range of patients, they now reflect limitations of the data supporting the use of β blockers in the management of many patient groups. Earlier guidelines from the American Heart Association/American College of
Acknowledgment
Michelle Daniels, MD, of inScience Communications provided medical writing support funded by Gilead Sciences, Inc.
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2017, SemergenThe Medical Treatment of Stable Angina
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The development of this manuscript was supported by Gilead Sciences, Foster City, CA.
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