At present, many doctors have two different misunderstandings. One is to worry about the metabolic side effects of β-blockers, which makes them difficult to use even for patients with indications. The other is that For patients with hypertension, even those with obesity, hypertriglyceridemia, metabolic syndrome, and diabetes, as long as the heart rate is faster, the beta blocker is preferred for blood pressure reduction at the time of presentation. The use of beta blockers has been debated in recent years. Therefore, the correct understanding and use of beta blockers is very important in antihypertensive therapy. Not long ago, a press conference on the publication of a pre-announcement was held by the "Regular Use of Beta Adrenergic Receptor Blockers" edited by Professor Hu Dayi of Peking University People's Hospital. At the press conference, experts pointed out that some clinicians should overcome the misunderstanding of the use of beta blockers and use these drugs correctly and in a standardized manner.
Insufficient understanding leads to improper application
The discovery and clinical application of beta blockers has been recognized as one of the major milestones in pharmacology and pharmacotherapeutics in the 20th century. As the Nobel Prize Committee gave a commentary to Dr. James Black's 1988 Physiological Medicine Award: "Since the discovery of digitalis 200 years ago, beta blockers have been a great breakthrough in the prevention and treatment of heart disease." With the publication of some clinical trial results in recent years, the UK's relevant guidelines have removed beta blockers from the first-line use of hypertension treatment. Professor Liu Meilin of Peking University* Hospital said that there is controversy about whether beta blockers are the drug of choice for hypertension treatment. In our clinical work, some clinicians do have some problems and cognitive deficiencies in the use of beta blockers, when to use them, when not to use them; how to make patients get the benefits of zui; How to use it is standardized; what should be the dose; what kind of patients should choose it, etc. Many doctors are not clear.
Beta blockers and another drug, digitalis, are two of the more difficult drugs used by clinicians in the treatment of cardiovascular disease. Professor Yan Xiaowei from Peking Union Medical College Hospital said that it is difficult for cardiovascular doctors to master these two types of drugs. For high-level experts in the diagnosis and treatment of cardiovascular diseases in China, the understanding of β-blockers is relatively thorough, and for the majority of clinicians, especially non-cardiovascular specialists, beta blockers There are a lot of confusions about the application of retardants. For example, he said that treatment with beta blockers can cause a drop in heart rate because it is a drug that lowers heart rate. Many clinicians saw that the patient's heart rate dropped from 94 beats/min to 64 beats/min after treatment. It was considered a serious matter, and it should be discontinued or should be reduced. In fact, this situation reflects the efficacy of the drug, indicating that the drug works. We hope that after the use of beta blockers, the patient's heart rhythm will be maintained between 64 beats / min ~ 74 beats / min; patients with heart failure maintained in the range of 55 beats / min ~ 60 beats / min.
Many clinicians have many concerns when using beta blockers, such as its effects on glycolipid metabolism, its effects on male sexual function, and the potential for airway contraction in patients with respiratory diseases. . It has a great relationship in the treatment of coronary heart disease, heart failure, hypertension, severe arrhythmia and other diseases. If there is no suitable dose in the application process, the patient will not fully benefit. These challenges have made clinicians often shrink their hands when using them. Therefore, Professor Yan Xiaowei said that many clinicians need to raise awareness in terms of patient selection, drug selection, and choice of drug delivery methods.
Professor Hu Dayi pointed out that because of the unique negative frequency effect of β-blockers, the heart rate of patients can be reduced. While reflecting its therapeutic effect, this feature puts forward the doctor's accurate grasp of the timing and dosage of clinical application. higher requirement. In addition, because the class effect of β-blockers is relatively small, the effects and side effects of different kinds of drugs are quite different. The adverse reactions of a certain drug are often emphasized and extended to the whole category, while the doctors and patients suffer from β The benefits of body blockers are still insufficiently understood, which affects the widespread use and dose compliance of beta blockers.
In the classic position in the treatment of coronary heart disease
The use of beta blockers has been controversial and discussed in recent years. But in some areas of cardiovascular disease treatment, it is still in a classic position. Professor Yan Xiaowei said that beta-blockers should also be used in the treatment of coronary heart disease, not only for patients with angina, but also for patients with acute coronary syndrome and patients with recessive, asymptomatic coronary heart disease. It not only improves symptoms but also improves prognosis. He said that beta blockers are comprehensive in the treatment of patients with coronary heart disease and are a type of evidence. The relevant guidelines are recommended as Class A. How to use this kind of drugs in patients with heart failure is a very serious clinical challenge. It took 20 years from the beginning of the trial to the clinical establishment of therapeutic status. Zui has recently confirmed that it is an effective drug for the treatment of patients with malignant arrhythmia, heart failure or myocardial infarction. Because the drug has a negative inotropic effect in early use, it can reduce myocardial contraction. Therefore, early treatment may aggravate the symptoms of heart failure, which makes its clinical application very difficult and requires a certain amount of experience from clinicians to use. He said that to tell the majority of clinicians, the use of beta blockers in heart failure is both very effective and full of certain risks.
Adverse reactions of beta blockers are important factors that affect physician use. Because there are some adverse reactions, and many people do not fully understand it, it limits its use. Professor Yan Xiaowei said that we should pay attention to how to improve the use of beta blockers in the clinic. Because in most clinical situations, patients are able to benefit from beta blocker therapy, the key is how to better use these drugs.
Treating hypertension is still the drug of choice
The current controversy over beta blockers is mainly focused on the treatment of hypertension. Yan Xiaowei said that β-blockers play an important role in the treatment of hypertension from the perspective of mechanism of action. In 2006, the British guidelines used the first-line beta blockers as a four-line drug. After the guide came out, it caused a wide range of discussions around the world. The European Guidelines for Hypertension in 2007 did not agree with the British guidelines that beta blockers, like other antihypertensive drugs, are suitable for initial and maintenance treatment of hypertension.
Last year, China has reached a clinical consensus on the use of domestic beta blockers in the treatment of hypertension. Experts believe that in evidence-based medicine, because some clinical trials have certain defects in design, the results have an important impact on the meta-analysis, and there is a bias. Although beta-blockers are not recommended as first-line drugs for antihypertensive therapy, they are different from ACEI and diuretics, and there are "non-class effects", that is, different types of beta blockers. There may be large differences in the role of compounds in certain aspects. Therefore, it can still be used as the drug of choice for a wide range of antihypertensive treatments in the population. In addition, in some specific cases, beta blockers are still the drug of choice for patients with six major indications, and it is wrong to completely reject its use in the treatment of hypertension.
Chinese patients are similar to foreign countries
In the past, many people think that Chinese patients have poor tolerance to β-blockers. It is believed that the dose of beta blockers should be much lower than in foreign countries. Professor Yan Xiaowei said that the reason for this understanding is mainly due to the use of the *type non-selective beta blockers used in the past. The drug tolerance varies widely between domestic and foreign. Later, the second and third generation of beta blockers were launched, and they have corresponding clinical registration studies in China. In these studies, it was found that domestic patients were less tolerant to second- and third-generation beta-blockers than in foreign countries. In the past, we thought that the dose of β-blockers should be smaller than that of foreign countries in China, because the size of the patients in China is small and the liver function is different. However, the clinical trials found that there is no significant difference between the target patients in China and the foreign patients. . Therefore, we emphasize that in order to benefit our patients, we need a relatively large dose for treatment.
How to judge whether the dose is suitable? Professor Yan Xiaowei said that in addition to the evidence of evidence-based medicine abroad, it is necessary to find out the dose that a patient can tolerate, or the clinically recommended dose, according to the patient's specific conditions, such as changes in heart rate and blood pressure after treatment. . In general, the use of beta blockers in most cases is a small to large process. (Reporter Zhu Guowang)
Insufficient understanding leads to improper application
The discovery and clinical application of beta blockers has been recognized as one of the major milestones in pharmacology and pharmacotherapeutics in the 20th century. As the Nobel Prize Committee gave a commentary to Dr. James Black's 1988 Physiological Medicine Award: "Since the discovery of digitalis 200 years ago, beta blockers have been a great breakthrough in the prevention and treatment of heart disease." With the publication of some clinical trial results in recent years, the UK's relevant guidelines have removed beta blockers from the first-line use of hypertension treatment. Professor Liu Meilin of Peking University* Hospital said that there is controversy about whether beta blockers are the drug of choice for hypertension treatment. In our clinical work, some clinicians do have some problems and cognitive deficiencies in the use of beta blockers, when to use them, when not to use them; how to make patients get the benefits of zui; How to use it is standardized; what should be the dose; what kind of patients should choose it, etc. Many doctors are not clear.
Beta blockers and another drug, digitalis, are two of the more difficult drugs used by clinicians in the treatment of cardiovascular disease. Professor Yan Xiaowei from Peking Union Medical College Hospital said that it is difficult for cardiovascular doctors to master these two types of drugs. For high-level experts in the diagnosis and treatment of cardiovascular diseases in China, the understanding of β-blockers is relatively thorough, and for the majority of clinicians, especially non-cardiovascular specialists, beta blockers There are a lot of confusions about the application of retardants. For example, he said that treatment with beta blockers can cause a drop in heart rate because it is a drug that lowers heart rate. Many clinicians saw that the patient's heart rate dropped from 94 beats/min to 64 beats/min after treatment. It was considered a serious matter, and it should be discontinued or should be reduced. In fact, this situation reflects the efficacy of the drug, indicating that the drug works. We hope that after the use of beta blockers, the patient's heart rhythm will be maintained between 64 beats / min ~ 74 beats / min; patients with heart failure maintained in the range of 55 beats / min ~ 60 beats / min.
Many clinicians have many concerns when using beta blockers, such as its effects on glycolipid metabolism, its effects on male sexual function, and the potential for airway contraction in patients with respiratory diseases. . It has a great relationship in the treatment of coronary heart disease, heart failure, hypertension, severe arrhythmia and other diseases. If there is no suitable dose in the application process, the patient will not fully benefit. These challenges have made clinicians often shrink their hands when using them. Therefore, Professor Yan Xiaowei said that many clinicians need to raise awareness in terms of patient selection, drug selection, and choice of drug delivery methods.
Professor Hu Dayi pointed out that because of the unique negative frequency effect of β-blockers, the heart rate of patients can be reduced. While reflecting its therapeutic effect, this feature puts forward the doctor's accurate grasp of the timing and dosage of clinical application. higher requirement. In addition, because the class effect of β-blockers is relatively small, the effects and side effects of different kinds of drugs are quite different. The adverse reactions of a certain drug are often emphasized and extended to the whole category, while the doctors and patients suffer from β The benefits of body blockers are still insufficiently understood, which affects the widespread use and dose compliance of beta blockers.
In the classic position in the treatment of coronary heart disease
The use of beta blockers has been controversial and discussed in recent years. But in some areas of cardiovascular disease treatment, it is still in a classic position. Professor Yan Xiaowei said that beta-blockers should also be used in the treatment of coronary heart disease, not only for patients with angina, but also for patients with acute coronary syndrome and patients with recessive, asymptomatic coronary heart disease. It not only improves symptoms but also improves prognosis. He said that beta blockers are comprehensive in the treatment of patients with coronary heart disease and are a type of evidence. The relevant guidelines are recommended as Class A. How to use this kind of drugs in patients with heart failure is a very serious clinical challenge. It took 20 years from the beginning of the trial to the clinical establishment of therapeutic status. Zui has recently confirmed that it is an effective drug for the treatment of patients with malignant arrhythmia, heart failure or myocardial infarction. Because the drug has a negative inotropic effect in early use, it can reduce myocardial contraction. Therefore, early treatment may aggravate the symptoms of heart failure, which makes its clinical application very difficult and requires a certain amount of experience from clinicians to use. He said that to tell the majority of clinicians, the use of beta blockers in heart failure is both very effective and full of certain risks.
Adverse reactions of beta blockers are important factors that affect physician use. Because there are some adverse reactions, and many people do not fully understand it, it limits its use. Professor Yan Xiaowei said that we should pay attention to how to improve the use of beta blockers in the clinic. Because in most clinical situations, patients are able to benefit from beta blocker therapy, the key is how to better use these drugs.
Treating hypertension is still the drug of choice
The current controversy over beta blockers is mainly focused on the treatment of hypertension. Yan Xiaowei said that β-blockers play an important role in the treatment of hypertension from the perspective of mechanism of action. In 2006, the British guidelines used the first-line beta blockers as a four-line drug. After the guide came out, it caused a wide range of discussions around the world. The European Guidelines for Hypertension in 2007 did not agree with the British guidelines that beta blockers, like other antihypertensive drugs, are suitable for initial and maintenance treatment of hypertension.
Last year, China has reached a clinical consensus on the use of domestic beta blockers in the treatment of hypertension. Experts believe that in evidence-based medicine, because some clinical trials have certain defects in design, the results have an important impact on the meta-analysis, and there is a bias. Although beta-blockers are not recommended as first-line drugs for antihypertensive therapy, they are different from ACEI and diuretics, and there are "non-class effects", that is, different types of beta blockers. There may be large differences in the role of compounds in certain aspects. Therefore, it can still be used as the drug of choice for a wide range of antihypertensive treatments in the population. In addition, in some specific cases, beta blockers are still the drug of choice for patients with six major indications, and it is wrong to completely reject its use in the treatment of hypertension.
Chinese patients are similar to foreign countries
In the past, many people think that Chinese patients have poor tolerance to β-blockers. It is believed that the dose of beta blockers should be much lower than in foreign countries. Professor Yan Xiaowei said that the reason for this understanding is mainly due to the use of the *type non-selective beta blockers used in the past. The drug tolerance varies widely between domestic and foreign. Later, the second and third generation of beta blockers were launched, and they have corresponding clinical registration studies in China. In these studies, it was found that domestic patients were less tolerant to second- and third-generation beta-blockers than in foreign countries. In the past, we thought that the dose of β-blockers should be smaller than that of foreign countries in China, because the size of the patients in China is small and the liver function is different. However, the clinical trials found that there is no significant difference between the target patients in China and the foreign patients. . Therefore, we emphasize that in order to benefit our patients, we need a relatively large dose for treatment.
How to judge whether the dose is suitable? Professor Yan Xiaowei said that in addition to the evidence of evidence-based medicine abroad, it is necessary to find out the dose that a patient can tolerate, or the clinically recommended dose, according to the patient's specific conditions, such as changes in heart rate and blood pressure after treatment. . In general, the use of beta blockers in most cases is a small to large process. (Reporter Zhu Guowang)
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