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Beta-blockers:
have compelling indications for heart failure, postmyocardial infarction, people
at high risk for coronary disease, and diabetes.
Other indications for beta-blockers include preoperative hypertension,
hyperthyroidism, atrial tachycardia, and atrial fibrillation.
Non-intrinsic sympathomimetic activity (non-ISA) beta-blockers such as
atenolol, esmolol, and metoprolol are indicated for treatment of myocardial
infarction if there are no contraindications to their use.
Propranolol and other non-cardioselective beta-blockers are indicated for
treatment of essential tremor and migraine headaches. -Beta-blockers
are generally contraindicated in patients with COPD and/or asthma, and patients
with 2nd or 3rd degree heart block.
Beta-blockers may worsen depression, peripheral vascular disease, cover
hypoglycemia symptoms, and prolong hypoglycemia episodes.
However, diabetics that receive beta-blockers and diuretics for
hypertension have an equal or increased reduction of cardiovascular events and
coronary heart disease compared with patients without diabetes.
Beta-blockers should be avoided in patients with Wolff-Parkinson-White
syndrome (WPW) and atrial fibrillation since these agents decrease conduction in
the AV node and produce increased conduction in the accessory pathway.
The increased conduction could lead to 1:1 conduction through the
accessory pathway from the atria to the ventricles and possibly produce
ventricular fibrillation. -Most
Beta-blockers are contraindicated in systolic heart failure except for
carvedilol, bisoprolol and metoprolol which are indicated for stable mild to
moderate heart failure. Some
studies have suggested that metoprolol succinate extended release is superior to
metoprolol tartrate (immediate release) in the treatment of heart failure.) -Sotalol
is not used to treat hypertension. It
is indicated to treat severe ventricular arrhythmias, such as life–threatening
sustained ventricular tachycardia.
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