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首页> 外文期刊>Progress in Cardiovascular Diseases >Cardiovascular drug class specificity: beta-blockers.
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Cardiovascular drug class specificity: beta-blockers.

机译:心血管药物类别特异性:β受体阻滞剂。

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beta-Adrenergic blockers are one of the most frequently prescribed cardiovascular drugs. Numerous beta-blockers are available for clinical use. Although these agents differ substantially, it is not clear whether (and which) differences are clinically relevant. Most of the important differences among agents reflect the relative specificity for beta(1)-, beta(2)-, and alpha-adrenergic receptors. Selection of a particular agent and target dose is probably best guided by available trial data, even though data are limited. Nonselective agents (with or without alpha-blocking properties) devoid of intrinsic sympathetic activity (ISA) are most appropriate postinfarction. Evidence exists demonstrating a mortality benefit postinfarction for propranolol, timolol, metoprolol, and, in the presence of left ventricular dysfunction, carvedilol. In the setting of heart failure, the selective agents metoprolol and bisoprolol as well as the nonselective agent carvedilol (which possesses alpha-blocking properties) have a demonstrated mortality benefit. Not all tolerated beta-blockers are associated with a survival benefit and it is probably not advisable to extrapolate benefits to all drugs with similar (although probably not identical) properties. Carvedilol may possess advantages over other beta-blockers and a possible survival advantage, suggested by the recent Carvedilol or Metoprolol European Trial (COMET), although these findings are not universally accepted. Ultimately, selection of a specific agent avoids obvious contraindications and uses trial data to guide selection and dose as long as side effects are absent or tolerable.
机译:β-肾上腺素能阻滞剂是最常用的心血管药物之一。许多β受体阻滞剂可用于临床。尽管这些药物有实质性差异,但尚不清楚(和哪些)差异在临床上相关。药物之间的大多数重要差异反映了β(1)-,β(2)-和α-肾上腺素受体的相对特异性。即使数据有限,选择特定药物和目标剂量也可能最好以可用的试验数据为指导。缺乏固有交感活性(ISA)的非选择性药物(具有或不具有α阻断特性)是最合适的梗塞后剂。有证据表明梗死后普萘洛尔,噻吗洛尔,美托洛尔以及存在左心功能不全的卡维地洛对死亡有益处。在心力衰竭的情况下,美托洛尔和比索洛尔的选择剂以及卡维地洛的非选择剂(具有α-阻滞特性)已显示出死亡率优势。并非所有可耐受的β受体阻滞剂都与生存获益相关,建议不要将获益推算到所有具有相似(尽管可能不相同)特性的药物上。尽管最近的卡维地洛或美托洛尔欧洲试验(COMET)提示,卡维地洛可能具有优于其他β受体阻滞剂的优势和可能的生存优势,尽管这些发现尚未被普遍接受。最终,只要没有副作用或可以耐受,选择一种特定的药物就可以避免明显的禁忌症,并使用试验数据来指导选择和剂量。

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