Beta-Blockers Through the Years

Everybody loves a list. The January 2018 issue of theJournal of Cardiovascular Nursingincludes a list of 20 things you didn't know about beta-blockers. Co-authored by an advanced practice registered nurse and a PharmD, the list includes facts about beta-blockers’ history, various uses, and subtleties.

Reading about a drug or drug category's development history often helps gain insight into the way we treat various conditions and how (and why) our treatment paradigms have changed. For example, the authors indicated that until the early 1990s, clinicians tended to avoid beta-blockers in individuals who have heart failure. Currently, beta-blockers are a mainstay for patients with heart failure and have been proven to extend life.

The list reminds readers that beta-blockers have been available for almost 60 years, although they weren't refined and identified as having significant clinical utility until decades later. Their importance is underscored by the fact that in 1964, Dr. James W Black won a Nobel Prize in medicine for his work on developing clinically useful beta-blockers.

Now, clinicians have their choice of beta-1 receptor selectivity or nonselective beta-blockers. Additionally, a few of these drugs have alpha-adrenergic activity.

In addition to use for cardiovascular conditions, beta blocker can also be prescribed to patients who have asthma. According to the authors, beta-blockers have been historically preferred in patients with asthma because they are less likely to provoke bronchospastic activity.

Beta-blockers can also be used in performers who have performance anxiety and have other unique uses like treatment of portal hypertension in patients with liver cirrhosis, delirium tremens, and hyperthyroidism. Propranolol is the beta-blocker of choice to treat symptoms of hyperthyroidism, the authors noted.

They are also more likely to cause adverse effects, such as depression and sexual dysfunction. This is because lipophilic beta-blockers, such as propranolol and pindolol, cross the blood-brain barrier and may be more likely to cause adverse effects associated with central nervous adrenergic blockade.

The authors noted that optimizing beta-blocker therapy is complicated and that responses to these drugs are dose-related and may be influenced by genetic variation, drug metabolism, and the patient’s underlying rhythm.

Reference

Vuckovic KM, Bursua A. 20 Things You Didn't Know About β-Blockers.J Cardiovasc Nurs. 2018;33(1):4-5.