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Why Beta Blockers Are a First Choice for Treating Heart Failure: These common drugs make patients feel better and live longer.

If you have systolic heart failure, you likely take carvedilol, metoprolol succinate or bisoprolol, along with other medications. That's because these beta-blockers are a cornerstone of therapy for systolic heart failure, no matter the cause.

"Beta-blockers have been shown to improve survival, reduce hospitalizations and improve the strength and size of the heart in patients with systolic heart failure. They also make patients feel better," says Cleveland Clinic heart failure specialist Miriam Jacob, MD.

In addition, beta-blockers have been shown to slow the progression of heart failure, improve its severity and reduce the risk of arrhythmias.

Beta-blockers are also important for the treatment of arrhythmias and coronary artery disease, in which they have been shown to improve survival and reduce the risk of future heart attacks and hospitalizations.

The Benefits of Blocking Beta Receptors

In systolic heart failure, the left ventricle weakens and has increasing difficulty ejecting blood out into the body. The body senses a crisis and floods the system with epinephrine (adrenaline) and norephinephrine. "This constant stimulation causes the heart to change its size and shape--a phenomenon we call remodeling," Dr. Jacob explains.

Beta-blockers intervene by preventing adrenaline from binding to alpha and beta receptors. Blocking adrenaline prevents the heart from accelerating and blood vessels from constricting. As a result, blood pressure and heart rate drop, and the heart no longer works overtime trying to do its job. In some patients, this can result in reverse remodeling, and the heart begins to regain its normal size and function.

Unfortunately, beta-blockers do not have an effect beyond blood pressure and heart rate lowering in patients with diastolic heart failure. In this condition, the heart's pumping power is preserved, but the ventricles become stiff and cannot fill properly with blood.

Getting Used to Taking Beta-Blockers

Overall, beta-blockers are safe medications. They do not interact with foods or most other drugs. Because beta-blockers lower blood pressure, however, hypertension medications not classically used in heart failure may need to be stopped when beta-blockers are started.

Patients with diabetes must be warned that beta-blockers may suppress the warning signs of low blood sugar. Of the three beta-blockers used in heart failure, carvedilol alone may make blood sugar somewhat harder to control.

In all patients, beta-blockers are titrated, meaning the dose is started low and gradually raised to reduce dizziness and fatigue.

"Patients may experience these side effects for the first couple weeks, but these feelings usually go away," says Dr. Jacob. "Sometimes, we have to adjust the dose based on the patient's blood pressure and heart rate.

"Overall, beta-blockers are very well tolerated by most of my patients."

Beta-Blockers for Life

Beta-blockers are so valuable in the treatment of heart failure that patients generally stay on the drug for life, even if their heart failure improves.

"If you stop taking a beta-blocker, your heart failure may worsen, because whatever triggered the condition will still be present," Dr. Jacob explains.

More often than not, beta-blockers simply slow the progress of this chronic disease. As heart failure advances, the day may come when the patient's blood pressure or heart rate is too low to tolerate beta-blockers any longer. Until this point, however, beta-blockers remain a mainstay of treatment.

"We want you to take advantage of their benefits as long as possible," says Dr. Jacob.

Beta-Blockers Used In Heart Failure

Seven beta-blockers are available. All can be prescribed to lower blood pressure, but only three are approved for treating heart failure. They are:

* bisoprolol (Zebeta)

* carvedilol (Coreg)

* metoprolol succinate (Toprol XL).

The drugs are so effective in increasing survival that The Joint Commission, an independent body that accredits and certifies healthcare organizations, requires that heart failure patients be given a prescription for beta-blockers when they are discharged from the hospital.
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Title Annotation:MEDICATIONS
Publication:Heart Advisor
Date:Jan 31, 2018
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