Differential Effect of β‐Blockers for Heart Rate Control in Coronary Artery Disease

Abstract

Background: Resting heart rate is an independent risk factor for cardiovascular disease and is mainly controlled by β-blockers (BBs). BBs are part of the optimal medical treatment for coronary artery disease (CAD), and their benefit correlates with resting heart rate (RHR) reduction. Hypothesis: RHR is poorly controlled in daily practice among patients with stable cardiovascular disease, and control is only achieved by some BBs. Methods: Observational, cross-sectional, and multicenter study of CAD patients recruited nationwide from 20 institutions. Antecedents, risk factors, and treatments were collected. Controlled RHR was considered at <70 bpm. Results: The mean age of the 2897 patients included was 67.4 years (11.4%), and 75.9% were males. Patients treated with a BB (56.5%) had a lower mean age and comorbidities. The mean RHR was 69.6 bpm (12.6). A significantly lower RHR was observed in patients treated with a BB compared to the rest (67.2 vs 73.0 bpm; P < 0.01), and no difference was observed in patients treated with a calciumchannel blocker (CCB). The analysis by individual agents identified that only patients treated with atenolol, bisoprolol, and metoprolol had significantly lower RHR than those not receiving a BB. No differences were observed in mean doses of each agent according to RHR control, except for verapamil. BB treatment was independently associated with RHR control (odds ratio [OR]: 2.42, 95% CI: 2.05-2.87; P < 0.01), and no association was found for nondihydropyridine CCBs (OR: 0.99, 95% CI: 0.96-1.02; P = 0.38). Bisoprolol (OR: 1.56, 95% CI: 1.38-1.78; P < 0.01), atenolol (OR: 2.01, 95% CI: 1.57-3.49; P < 0.01), and metoprolol (OR: 1.29, 95% CI: 1.04-1618; P = 0.04) were independently associated with RHR control. Conclusions: RHR is poorly controlled in CAD patients, and although BBs are the most efficient therapy, in daily clinical practice RHR <70 bpm is only independently associated with atenolol, bisoprolol, or metoprolol.

The Role of Ivabradine in Cardiac Rehabilitation in Patients With Recent Coronary Artery Bypass Graft

“…12 The different mechanisms of action of ivabradine and beta-blocker responsible for reducing heart rate mean the combination of ivabradine with low-dose bisoprolol appears to be a valuable option in patients with CABG undergoing cardiac rehabilitation. 12,30 Limitations As resting heart rate reduction may not be a class effect of beta-blockers, 9 caution should be used in interpreting our findings with the beta-blocker bisoprolol more generally. Our study examined several efficacy parameters, but data on the safety and tolerability of the combination are lacking.…”

“…As resting heart rate reduction may not be a class effect of beta-blockers, 9 caution should be used in interpreting our findings with the beta-blocker bisoprolol more generally. Our study examined several efficacy parameters, but data on the safety and tolerability of the combination are lacking.…”

“…These benefits have been demonstrated in patients with stable coronary artery disease and in patients with chronic heart failure. 9,10 Accordingly, heart rate reduction has been proposed as a therapeutic target in ischemic heart disease. 11,12 The use of a ''pure'' heart rate-lowering drug such as ivabradine would be useful for assessing benefit related to heart rate reduction alone.…”

Effect of Metoprolol Succinate in Patients with Stable Angina and Elevated Heart Rate Receiving Low-Dose β-Blocker Therapy

“…The effectiveness of β-blockers in controlling HR is well established. According to one report, atenolol, bisoprolol, and metoprolol were more effective than other β-blockers in managing resting HR in CHD patients 9 . Previous studies of multiple patient groups have demonstrated that changes in both 24-h average HR and resting HR were related to the dosage of β-blocker administered 18 , 19 .…”

“…β-blockers are among the most effective therapies for CHD. The clinical benefit and improvement in prognosis following β-blocker treatment in CHD patients have been associated with a reduction in resting HR 9 . In patients who have stable angina without contraindications, β-blocker therapy is recommended as a strategy to improve disease outcome and symptoms.…”