Over the past several years, evidence has been accumulating that shows beta blockers are useful drugs in treating heart failure. A study named the COPERNICUS trial tested the use of beta blockers in 2200 patients. The patients were randomly assigned to either the carvedilol treatment group or the placebo treatment group. Both groups were given ACE inhibitors, diuretics, and digitalis. The results showed a 35% improvement in patients who received the carvedilol and was even greater in patients with very severe heart failure. These patients also did no show any additional side effects than those treated with the placebo. Similar studies were also done using bisoprolol and metoprolol with comparable results. These drugs have been proven to not only improve quality of life, but also improve the chances of survival (Fogoros).
It has also been shown that post myocardial infarction, beta blockers are effective in preventing further MIs or other life threatening cardiac events while calcium-channel blockers have been shown to be ineffective. The explanation for this is still unknown, but the evidence is overwhelming in favor of beta blockers (Singh).
Another study, the Survival and Ventricular Enlargement or SAVE trial, showed that the use of beta blockers resulted in a 30% reduction in cardiac death, a 21% reduction in heart failure, and an 11% reduction in recurrent MIs 42 months post MI (Herrmann).
Studies have also shown that beta blockers are equally effective in men and women (American Heat Association).
A study done by the School of Pharmacy and Institute for Health Policy Studies showed that using beta blockers for all MI survivors, except those with significant contraindications, in the year 2000 and remained on the medication for 20 years would result in 4300 fewer CHD deaths, 3500 MIs prevented, and 45,000 life-years gained compared with current use. If this policy were carried out over 20 years, beta blockers would save $18 million and result in 72,000 fewer CHD deaths, 62,000 MIs prevented, and 447,000 life-years gained (Phillips).
Researchers at the Keck School of Medicine showed that beta blockers were also useful in reducing the risk of death in patients with chronic severe mitral regurgitation or congestive heart failure with normal ejection fraction. The study showed that 65% of these patients on a beta blocker were alive after five years, while only 50% of those not on a beta blocker were alive (Ramdas
Every drug comes with its side effects. When taking a beta blocker, syncope, often referred to as dizziness or lightheadedness, is a side effect that may be strongest when you change position, such as from laying to sitting or standing. Fatigue, headaches, and insomnia can also accompany this class of drugs. Weight gain is more common as your doctor increases the dose of the medication you receive. Dyspnea, bradycardia, and arrhythmias have also been reported with patients using beta blockers. Another side effect that only affects men is impotence. A study in the October 20, 2008 issue of Health Day News showed that the death rate for people given beta blockers before a non-cardiac surgery was ten times higher and the rate of post-operative acute myocardial infarctions was four times higher in the thirty days following an operation than those not getting the drugs. Beta blockers may also cause hyperglycemia; therefore, diabetic patients prescribed beta blockers must be closely monitored. If you are not a diabetic, beta-blockers may also increase your chances of developing diabetes.
After evaluation of the evidence along with consideration of outside sources, we found that many cardiologists agree that caution must be exercised in prescribing beta blockers because it may harm some patients but can clearly benefit others who are at the highest risk of complications post-operatively and with risk factors for cardiovascular disease (Bio-Medicine).
References:
Bullock, C. (2002, March 11). In heart failure, beta-blockers boost survival advantage for women [Online exclusive]. Bio-Medicine. Retrieved from http://news.bio-medicine.org/medicine-news-2/In-heart-failure–beta-blockers-boost-survival-advantage-for-women-8668-1/
Fogoros, R.N. (2003, November 30). Beta blockers in heart failure [Online exclusive]. About.com. Retrieved from http://heartdisease.about.com/cs/heartfailure/a/bbinhf.htm
Herrmann, H.C. (1997, March 11). Beta blockers add benefits after MI [Online exclusive]. Journal Watch. Retrieved from http://cardiology.jwatch.org/cgi/content/full/1997/311/1
Phillips, K.A., Shlipak, M.G., Coxson, P., Heidenreich, P.A., Hunink, M.G.M, Goldman, P.A., Williams, L.W., Weinstein, M.C., & Goldman, L. (2000, December 6). Health and economic benefits of increased beta-blocker use following myocardial infarction. The Journal of the American Medical Association, 284, 2748-2754. Retrieved from http://jama.ama-assn.org/cgi/content/abstract/284/21/2748
Singh, B.N.(1990, September 5). Advantages of beta blockers versus antiarrhythmic agents and calcium antagonists in secondary prevention after myocardial infarction [Web exclusive]. The American journal of cardiology. Retrieved from http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Retrieve&list_uids=1699400&dopt=abstractplus
Varadarajan, P., Appel, D., Joshi, N., Duvvuri, L., & Pai, R.G. (2005, March 8). Beta-blockers may help broader group of patients with heart problems [Online exclusive]. Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/20875.php
October 10, 2009 at 3:22 am |
I love my beta-blocker. It has allowed me to live a normal life instead of constantly being worn out due to my chronic (idiopathic) tachycardia (diagnosed as Inappropriate Tachycardia Syndrome with Postural Orthostatic Intolerance).
One side effect that I experienced, that isn’t talked about very often is depression. My doctor felt that the beta-blocker was so necessary for me to have a normal life that he added an antidepressant instead of discontinuing the beta-blocker.
Also people on beta-blockers (even if it is being used to manage tachycardia) should be very careful to take their medication EVERY DAY, if you miss a dose, you will a. feel terrible all day long, b. experience a spike in blood pressure and c. notice a pronounced rebound of the tachycardia.
October 11, 2009 at 1:28 am |
When doing patient teaching for chronic health problems, I often use diabetes and insulin as examples of the importance of properly taking medication. With Beta Blockers for CHF, I equate the importance of proper medication administraion as well. It helps the patients put into perspective the taking the medication daily, and no skipping doses.
October 11, 2009 at 5:03 pm |
As with any medication, I believe that education is of upmost importance. If the patient is made aware of the risk factors then he/she can made an informed decision. For some people it is worth taking the medicine despite the risks. For others, they would rather take the risk of not using the medication. Either way the most important thing is to make the patient aware of the risks/benefits related to any type of medication.
October 14, 2009 at 4:59 pm |
I had not realized that a possible side effect of beta-blockers is depression! Is that common? That is good to know! I don’t remember going over that in class. I will be sure to remember that in practice! Thanks for commenting on our site!
October 14, 2009 at 9:00 pm |
Well said. Could it also be possible to reduce the risks of heart failure through a change in lifestyle, or is medicine necessary?
October 24, 2009 at 12:07 am |
Brian, generally a change in lifestyle does not produce a significant effect for reducing the risk of heart failure or treating it. If you are at risk for heart failure or have already been diagnosed with it, you should be on medicine to be safe and prevent future damage. A beta blocker with a diuretic is a common combination that is used to treat heart failure. The beta blocker slows the heart down and the diuretic reduces the fluid volume so that the heart doesn’t have to work so hard to pump the blood. Good question!! : )
October 27, 2009 at 10:18 am |
Great information! My husband is currently taking Amlodipine/Benazepril (a calcium channel blocker/ACE inhibitor) for hypertension. And it makes sense to me now why his physician may have chose those over a beta blocker, as he is not considered a profoundly “high risk” patient for cardiovascular disease.