The clinical understanding of the application of β - blocker is still insufficient

At present, many doctors have two different misunderstandings in clinical practice One is that they are worried about the side effects of β receptor blocker on metabolism, which makes them dare not to use it even for patients with indications; the other is that for patients with hypertension, even those with obesity, hyperglycinemia, metabolic syndrome and diabetes, as long as the heart rate is fast, β receptor blocker will be used when they see a doctor Receptor blockers reduce blood pressure There are some controversies about the use of β - blockers in recent years Therefore, it is very important to recognize and use β - blocker in antihypertensive therapy Not long ago, a press conference was held on "regulating the use of β - adrenergic receptor blockers" edited by Professor Hu Dayi of Peking University People's hospital At the conference, experts pointed out that some clinicians should overcome the misunderstanding of using β - blockers and use them correctly and normatively The discovery and clinical application of inappropriate β - blockers caused by lack of recognition have been regarded as one of the major milestones in pharmacology and pharmacotherapy in the 20th century As the Nobel Committee commented in awarding Dr James Black the 1988 physiological medicine prize, "since the discovery of digitalis 200 years ago, β - blockers have been a great breakthrough in the prevention and treatment of heart disease by drugs." However, with the results of some clinical trials published in recent years, the relevant guidelines in the UK have withdrawn beta blockers from the first-line treatment of hypertension Liu Meilin, a professor at Peking University Hospital, said that there is a dispute in the world about whether β - blockers are used as drugs to treat hypertension In the clinical work of our country, some clinicians do have some problems and lack of understanding in the use of β receptor blocker, such as when to use it, when not to use it; how to make patients get big benefits of Zui; how to use it is standard; how to use it; what dose should be; what kind of patients should choose it, etc., many doctors are not clear β - blocker and digitalis, another drug, are two kinds of drugs which are difficult to be used by clinicians in the treatment of cardiovascular diseases Professor Yan Xiaowei of Peking Union Medical College Hospital said that Zui, a cardiologist, is hard to master these two kinds of drugs For the high-level experts in the diagnosis and treatment of cardiovascular diseases in China, they have a relatively thorough understanding of β receptor blockers For the majority of clinicians, especially non cardiovascular specialists, there are many puzzles in the application of β receptor blockers For example, he said, the use of beta blockers can cause a drop in heart rate, because it is the drug that lowers the heart rate Many clinicians saw the heart rate of patients decreased from 94 times / min to 64 times / min after treatment They thought it was a very serious thing, and they thought it should be stopped or reduced In fact, this situation reflects the efficacy of the drug, indicating that the drug works We hope that after the use of β - blocker, the heart rate of patients will be maintained between 64 times / min and 74 times / min; for patients with heart failure, it will be maintained between 55 times / min and 60 times / min Many clinicians still have many concerns when using β - blocker, such as its impact on glucose and lipid metabolism, the impact on male sexual function, and the potential possibility of airway contraction in patients with respiratory diseases It has a great relationship with dosage in the treatment of coronary heart disease, heart failure, hypertension, serious arrhythmia and other diseases If there is no appropriate dosage in the process of application, patients will not fully benefit These problems make clinicians shrink when using them Therefore, Professor Yan Xiaowei said that many clinicians need to improve their awareness of patient selection, drug selection, drug delivery method selection and other aspects Professor Hu Dayi pointed out that β receptor blocker has a unique negative frequency effect, which can reduce the heart rate of patients While reflecting its therapeutic effect, this characteristic also puts forward higher requirements for doctors to accurately grasp the timing and dosage of clinical application In addition, due to the relatively small class effect of β - blocker, different kinds of drugs have great differences in efficacy and side effects, the adverse reactions of a certain drug are often one-sided emphasized and extended to the whole class, while the benefits of β - blocker are still not fully understood by doctors and patients, which affects the general use of β - blocker and the dose standard In recent years, there are many controversies and discussions about the use of β - blocker in the treatment of coronary heart disease However, in some areas of cardiovascular disease treatment, it is still in a classic position Professor Yan Xiaowei said that in the treatment of coronary heart disease, beta blockers should be used not only for patients with angina, but also for patients with acute coronary syndrome and patients with recessive and asymptomatic coronary heart disease It can not only improve symptoms, but also improve prognosis He said that the treatment of β - blockers for patients with coronary heart disease is a kind of evidence, and the relevant guidelines are recommended as A-level How to use this kind of drugs in patients with heart failure has a great challenge in clinical practice It took 20 years from the beginning of trial use to the establishment of clinical treatment status Zui has been proved to be an effective drug for the treatment of Zui in patients with malignant arrhythmia, heart failure or myocardial infarction The early use of the drug has a negative inotropic effect, which can reduce myocardial contraction Therefore, the early treatment may aggravate the symptoms of heart failure, which makes its clinical application very difficult It needs clinicians to accumulate certain experience to use it well Tell clinicians that beta blockers are both effective and risky in heart failure, he said The side effect of β - blocker is an important factor affecting the use of doctors Because there are some adverse reactions, and many people do not fully understand it, which limits its use Professor Yan Xiaowei said that we should pay attention to how to improve the use rate of beta blockers in clinical practice Because in most clinical cases, patients can benefit from β - blocker therapy, the key is how to use these drugs better The treatment of hypertension is still a drug Now the controversy of β - blocker mainly focuses on the treatment of hypertension Yan Xiaowei said that in terms of mechanism of action, beta blockers play an important role in the treatment of hypertension In 2006, the British guidelines put the former first-line β - blocker as the fourth-line drug After the guide came out, it has been widely discussed all over the world In 2007, the European guideline on hypertension did not agree with the British guideline It believed that β - blockers, like other antihypertensive drugs, were suitable for the initial and maintenance treatment of hypertension Last year, China has reached a consensus on the treatment of hypertension with β - blockers Experts believe that in evidence-based medicine, because some clinical trials have some defects in design, the results have an important impact on the meta-analysis, showing a bias Although β receptor blocker is not recommended as the first-line medication for antihypertensive therapy by some guidelines, it has "non class effect" because it is different from ACEI and diuretics, that is, in the same type of β receptor blocker, different compounds may have different effects in some aspects Therefore, it can still be widely used as antihypertensive drugs in the population In addition, in some specific cases, β - blocker is still the drug for patients with six major indications It is wrong to completely deny its application in the treatment of hypertension The tolerance of Chinese patients is similar to that of foreign countries In the past, many people think that the tolerance of Chinese patients to β - blockers is relatively poor The dosage of β - blocker should be much lower than that of foreign countries Professor Yan Xiaowei said that the reason for this recognition is mainly from propranolol, a non selective beta receptor blocker used in the past The tolerance of the drug is very different between domestic and foreign countries Later, the second and third generation beta blockers have been listed successively, and they have corresponding clinical registration studies in China In these studies, it was found that there was no significant difference in the tolerance of second and third generation beta blockers between Chinese and foreign patients In the past, we thought that the dosage of β - blocker used by Chinese patients should be smaller than that of foreign patients, because the body shape of Chinese patients is smaller and the liver function is also different, but later clinical trials found that there is no obvious difference between Chinese patients and foreign patients in reaching the target dosage Therefore, we emphasize that in order to benefit our patients, we also need a large dose of treatment How to judge whether the dose is appropriate? Professor Yan Xiaowei said that in addition to referring to the evidence of foreign evidence-based medicine, it is also necessary to explore a large tolerable dose of Zui or the clinically recommended dose according to the specific situation of patients, such as the change of heart rate and blood pressure after treatment Generally speaking, the dosage of β - blocker is a process from small to large (reporter Zhu Guowang)