IMR Press / RCM / Volume 5 / Issue S1 / pii/1561344983643-733651564

Reviews in Cardiovascular Medicine (RCM) is published by IMR Press from Volume 19 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with MedReviews, LLC.

Open Access Review
Practical Considerations for Switching β-Blockers in Heart Failure Patients
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1 Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, The Ohio State University Heart Center, Columbus, OH
2020 Division of Cardiovascular Medicine, The Ohio State University Heart Center, Columbus, OH
Rev. Cardiovasc. Med. 2004, 5(S1), 36–44;
Published: 20 January 2004
Abstract
The use of β-blocker therapy has proven extremely useful in a variety of clinical settings, including the management of hypertension, acute- and post-myocardial infarction, and in congestive heart failure (HF). However, there are noticeable differences among individual β-blockers in regard to efficacy of treatment and clinical outcomes in many of these conditions. These differences are particularly apparent in the treatment of HF, where effects on reverse remodeling and interactions on the periphery are potential factors that can differentiate between the efficacy of one drug versus another. In fact, β-blockers are not a singular, homogeneous group, but rather a class made up of a number of agents with individual differences in pharmacology, receptor biology, hemodynamic effects, and tolerability. In the event of ongoing disease progression, the onus of choosing the most appropriate ß-blocker falls on the clinician's shoulders. Given the baseline differences among medications of this class, the rationale and manner for transitioning to a different β-blocker should take into account the specific receptor-blockade subtype of any given agent, as well as any other intrinsic effects attributed to a specific drug. This article includes 2 protocols for switching between carvedilol, a third generation non-selective agent with vasodilatory properties through α1-blockade, and a ß1-selective agent (e.g., metoprolol, atenolol). The aim is to simplify and maximize the safety and tolerability of performing this exchange. With the increasing amount of clinical evidence supporting the use of one β-blocker over another in the treatment of HF, it behooves physicians treating this patient population to utilize the adrenergic blocking agent that provides optimal therapy with minimal side effects and intolerability.
Keywords
Heart failure
ß-Blockers
Carvedilol
Metoprolol CR/XL
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