Beta blocker drugs for hypertension and heart disease

Treatment of cardiac diseases in modern medical practice is almost impossible to imagine without the use of a special group of drugs - beta blockers.

The list of diseases for which therapy using these drugs is used is extensive. They effectively normalize blood pressure levels and heart rate.

However, like any medications, beta blockers require caution and care during therapy.

Letters from our readers

Topic: Grandma's blood pressure has returned to normal!

From: Christina ( [email protected] )

To: Administration otgipertonii.ru

Christina, Moscow

My grandmother’s hypertension is hereditary - most likely, I will have the same problems as I get older.

I accidentally found an article on the Internet that literally saved my grandmother. She was tormented by headaches and had a repeated crisis. I bought the course and monitored the correct treatment.

After 6 weeks she even started talking differently. She said that her head no longer hurts, but she still takes pills for blood pressure. I am sending a link to the article

Indications for use

Beta blocker drugs are used in the treatment of the following diseases:

• a chronic condition of high blood pressure in the body;
• increased blood pressure due to other pathologies;
• increased rhythm of contractions of the heart muscle;
• painful sensations in the heart with diagnosed coronary artery disease;
• rehabilitation period after a previous heart attack;
• pathological changes in heart rate;
• functional disorders in the myocardium;
• thickening of the ventricular wall;
• abnormal increase in the size of the ventricle and septum;
• a condition in which the mitral valve protrudes into the cavity of one atrium at the time of contraction of the other;
• asynchronous contraction of ventricular myocardial cells or risk of sudden death;
• high blood pressure due to surgery;
• migraine;
• alcohol and drug addiction.

List of complex drugs

One of the best beta blockers for hypertension and heart disease is Nebivolol. This is a drug of the latest generation with a long-term therapeutic effect. It has many advantages:

• quickly reduces blood pressure without causing hypotension;
• a minimum of undesirable reactions of the body to the components of biologically active substances;
• does not affect potency;
• does not affect levels of bad cholesterol;
• does not change glucose concentration;
• protects cells from external harmful factors that can damage their integrity;
• approved for use by diabetics and patients with insulin resistance syndrome;
• normalizes blood flow;
• does not narrow the lumen of small bronchi and bronchioles;
• To achieve a therapeutic effect, you need to take the tablets once a day.

Nebivolol is one of the best drugs in the group of beta-blockers

Classification

Drugs in this group have several classifications, which divide drugs according to various criteria.

All beta blockers are divided depending on the characteristics of their effect on receptors:

• non-selective drugs;
• selective drugs.

A group of non-selective drugs do not have the ability to select adrenergic receptors for blocking. They affect all structures.

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This effect on the body manifests itself in the form of a decrease in blood clotting and a decrease in the number of plaques, the level of pressure in the blood vessels also decreases, the rhythm of myocardial contractions is normalized, and cell membranes are stabilized.

The most popular drugs among non-selective beta blockers are:

• Anaprilin;
• Sandinorm;
• Vistagen;
• Korgard;
• Vistagan;
• Trazikor;
• Visken;
• Sotalex;
• Okumol;
• Obzidan.

The cost of these drugs is very diverse and varies from 50 rubles. up to 1000 rub. per package.

Selective beta blockers work specifically at a specific type of receptor. The second name of this group is cardioselective. Blocked receptors are located in the cells of the myocardium, lipoid tissue, and also in the intestines.

The main advantage of this group is that they can be taken by people who have diabetes and a tendency to develop bronchospasms.

Representatives of the selective group are:

• Metoprolol;
• Tenormin;
• Lokren;
• Esmolol;
• Bisoprolol;
• Coriol;
• Nebikor;
• Cordanum;
• Vazacor;
• Acekor.

The cost of drugs in pharmacies varies. It depends on the manufacturer, the concentration of the active ingredient, and the number of tablets in the package.

Domestic drugs are much cheaper than foreign analogues. Their cost, as a rule, does not exceed 250 rubles. Foreign funds have a price above 500 rubles.

In addition to selectivity, the classification can be based on the progressiveness and novelty of the drug. Thus, among the drugs in the group of beta blockers, 3 generations are distinguished.

The 1st generation of drugs is characterized by non-selective action. These include:

• Propranolol;
• Sotalol;
• Timolol.

The 2nd generation of drugs from the beta blocker group includes selective drugs:

• Metoprolol;
• Bisoprolol;
• Esmolol.

The 3rd generation of drugs combines selective and non-selective effects:

• Talinolol;
• Celiprolol;
• Carteolol.

Currently, it is 3rd generation drugs that are most often used. They have the least number of contraindications and side effects.

However, you cannot choose your own medicine. This can only be done by the attending physician based on the results of a general examination of the body.

Classification of drugs

There are four types of adrenergic receptors in the walls of blood vessels (alpha 1 and 2, beta 1 and 2). Drugs from the group of adrenergic blockers can block different types of receptors (for example, only beta-1 adrenergic receptors). Drugs are divided into groups depending on the shutdown of certain types of these receptors:

Alpha blockers:

• alpha-1 blockers (silodosin, terazosin, prazosin, alfuzosin, urapidil, tamsulosin, doxazosin);
• alpha-2 blockers (yohimbine);
• alpha-1, 2-blockers (dihydroergotamine, dihydroergotoxin, phentolamine, nicergoline, dihydroergocristine, proroxan, alpha-dihydroergocriptine).

Beta blockers are divided into the following groups:

• non-selective adrenergic blockers (timolol, metypranolol, sotalol, pindolol, nadolol, bopindolol, oxprenolol, propranolol);
• selective (cardioselective) adrenergic blockers (acebutolol, esmolol, nebivolol, bisoprolol, betaxolol, atenolol, talinolol, esatenolol, celiprolol, metoprolol).

List of alpha-beta adrenergic blockers (they include alpha and beta adrenergic receptors at the same time):

• labetalol;
• proxodolol;
• carvedilol.

Please note: The classification shows the names of the active substances that are part of the drugs in a certain group of blockers.

Beta blockers also come with or without intrinsic sympathomimetic activity. This classification is considered auxiliary, since it is used by specialists to select the necessary medicine.

List of drugs

Common names for alpha-1 blockers:

• Alfuzosin;
• Dalfaz;
• Artesin;
• Zoxon;
• Urocard;
• Prazosin;
• Urorek;
• Miktosin;
• Tamsulosin;
• Cornam;
• Ebrantil.

Alpha-2 blockers:

• Yohimbine;
• Yohimbine hydrochloride.

Alpha-1,2-blockers:

• Redergin;
• Ditamine;
• Nicergoline;
• Pyrroxane;
• Phentolamine.

Selective beta blockers:

• Atenol;
• Atenova;
• Atenolan;
• Betacard;
• Tenormin;
• Sectral;
• Betoftan;
• Xonephus;
• Optibetol;
• Bisogamma;
• Bisoprolol;
• Concor;
• Tirez;
• Betalok;
• Serdol;
• Binelol;
• Cordanum;
• Breviblock.

Non-selective beta blockers:

• Sandorm;
• Trimepranol;
• Visken;
• Inderal;
• Obzidan;
• Darob;
• Sotalol;
• Glaumol;
• Thymol;
• Timoptic.

Alpha-beta blockers:

• Proxodolol;
• Albetor;
• Bagodilol;
• Carvenal;
• Credex;
• Labetol;
• Abetol.

The highest quality and most effective Beta blocker

The leading position in terms of effectiveness is occupied by a group of 3rd generation beta blockers. This is the most modern and progressive type of drugs that act on adrenergic receptors.

The best among them are considered to be drugs under the trade name Nebivolol Sandoz, as well as Carvedilol.

Carvedilol is a selective drug. During the period of its use, there is an effective decrease in the level of pressure in the blood vessels due to the expansion of the lumen, and the number of plaques also decreases.

Nebivolol – combines 2 types of action. It effectively reduces blood pressure and also helps in the fight against heart disease. Nebivolol is a more expensive drug than Carvediol.

Beta blockers list of drugs for tachycardia

Adrenaline stimulates the heart muscle. Its release accelerates the pulse, increases blood pressure and makes the cardiovascular system work like a horse. A person can make supernatural jumps, lift unimaginable weights, etc.

On the contrary, inhibition of cardiac activity occurs due to a decrease in the effects of stimulant substances. The pulse slows down, and with it the blood flow, the pressure decreases, in general, the heart is in no hurry.

Slowing down our heart rate gives our motor the opportunity to relax and gain strength. This ability of the heart is widely used in medicine. And our topic today is beta blockers, medications that give the heart a break.

The names of all beta blockers end in “-lol”

The group of drugs that give the heart proper rest is easy to distinguish from the rest: the names of all beta blockers end in “-lol”.

The action of beta blockers is based on a decrease in the activity of the sympathetic nervous system, which is responsible for the bright emotional coloring of stressful situations (anger, anxiety, excitement).

By suppressing these manifestations, you can increase stress resistance, including protecting the heart from unnecessary anxiety. Then the grateful heart contracts less often and with less force, which reduces its need for oxygen. As a result, attacks of angina pectoris and rhythm disturbances disappear as if by magic, and the risk of sudden death due to the fault of the heart is minimized.

The receptors that are affected by adrenaline and similar stimulating substances (β1) are also found in blood vessels.

Blockade of these receptors relieves tension in the vascular wall, and with it high blood pressure.

In turn, a decrease in heart rate and cardiac output leads to a decrease in the body’s production of vasoconstrictor substances, which inhibit the functioning of the central nervous system and disrupt the nutrition of the vascular wall.

Drugs worthy of a Nobel Prize

The first beta blocker (protenalol) was synthesized in 1962. It increased the incidence of cancer in mice, which is why it did not make it past the experimental stage. A couple of years later, propronalol appeared, for the development of which (with a detailed description of the mechanism of action of the entire group of beta blockers) the Americans J. Black, G. Elion, G. Hutchings subsequently received the Nobel Prize in 1988. True, at first the medicine was conceived to treat arrhythmia, and its ability to reduce blood pressure was perceived as a side effect. Time has shown that both are important for the heart.

Photo from russia-now.com

The latest generation drug, nebivolol, entered the market in 2001. “Know-how” of the 21st century, this medicine showed, in addition to its previous properties, a unique ability to stimulate the production of a powerful vasodilator in the body - nitric oxide.

Today in clinical practice we use no more than 5 drugs from the beta-blocker group: metoprolol, bisoprolol, carvedilol, betaxalol, nebivolol.

Some of them are preferable for normalizing high blood pressure, others for the treatment of angina pectoris, and others for heart rhythm disorders. Of course, each subsequent generation of drugs works better than the previous one.

Points of application of magic drugs - and hangover syndrome there too

Beta blockers are used in the following cases:

• hypertension (to reduce blood pressure due to the vasodilating effect);
• coronary heart disease (to prevent and treat attacks of angina and other pain in the heart area);
• tachycardia (to reduce the frequency and strength of heart contractions);

• heart failure (to relieve the heart and blood vessels);
• metabolic syndrome (to block the key mechanisms of disease development - the release of adrenaline);
• myocardial infarction (to improve survival and prognosis);

• some heart rhythm disorders, in particular long QT syndrome (the disease carries a high risk of sudden death);
• other arrhythmias manifested by rapid heartbeat;
• diabetes mellitus (for cardioprotection, vasodilatory effect).

Beta blockers are also included in the complex treatment of migraines, vegetative crises, hangover syndrome (reduce the manifestations of adrenaline release), hypertrophic cardiomyopathy (reduce the risk of arrhythmia).

How to Find Your Beta Blocker

Only your doctor can decide whether beta blocker medications are right for you. He also chooses the name of the drug, taking into account its generation and indications (without aggravating concomitant diseases), selects the dose - gradually, taking into account pulse (target value 55-60 beats / min) and pressure (at least 100/60 mm Hg. ). The doctor also determines the frequency of administration, which depends on the generation of the drug.

Unauthorized prescription of beta blockers can play a cruel joke - due to possible complications.

Consequences of incorrect use of beta blockers. Rebound syndrome

The effect of drugs on the autonomic nervous system allows them to be successfully used at a young age.

It’s a completely different matter for an elderly person whose many concomitant diseases are not always compatible with medications.

The main side effects of beta blockers are:

• A decrease in heart rate is fraught with excessive bradycardia, the cardiac impulse has difficulty making its way from the atria to the ventricles (atrioventricular blockade).
• The bronchi narrow, the production of mucus in them decreases, which threatens the narrowing of the lumen of the bronchi and wheezing (bronchial obstruction).

• Hypotonic people risk reducing their blood pressure to a critical level, when the brain stops receiving blood and oxygen.
• Diabetics are at risk for episodes of sudden, uncontrolled low blood sugar.

• Cholesterol plaques become larger.
• The legs become cold, weak, and have goosebumps (the drug narrows the peripheral arteries).
• People prone to depression become even more gloomy.
• Sexual function is impaired (“plus” impotence, “minus” libido).

A pill not taken on time will remind you of itself with an adrenaline surge and a rapid return of symptoms of high blood pressure, arrhythmia, and angina attacks.

“Rebound syndrome” upon drug withdrawal (with long-term treatment) is associated with renewed sensitivity of β-adrenergic receptors.

Thus, magic is magic, and you need to know when to stop. Medicines work “with a bang” only if they are used as directed. Look for a competent doctor.

How do beta blockers affect blood pressure?

Beta blockers block the work of special adrenergic receptors in the body, which are located in the cells of cardiac muscle tissue, liver, fatty tissue, etc. As a result of a decrease in receptor activity, the following changes occur in the body:

• the heart rate slows down somewhat and myocardial cells require less oxygen;
• the process of blood flow in the coronary region is normalized and high-quality nutrition of the heart muscle occurs;
• the substance renin is produced, which reduces peripheral resistance;
• special active biological substances are produced that expand the vascular lumen;
• cell membranes become less permeable to sodium and potassium ions.

All of these processes occur almost simultaneously, due to this, a decrease in blood pressure occurs. Additionally, the effect of normalizing heart rate and myocardial function is noted.

Mechanism of action of beta blockers

The beta blocker realizes its effect by blocking B1 and B2 adrenergic receptors, which are responsible for the structural and functional characteristics and distribution in the tissues of the body. Type B1 adrenergic receptors predominate in the heart, pancreas and renal apparatus.

Beta blockers, the mechanism of action of which is based on blocking certain receptors, bind to B1 adrenergic receptors and interfere with the action of adrenaline and norepinephrine. Beta 1.2 adrenergic blockers are responsible for:

1. Reducing heart rate.
2. Decreased strength of heart contractions.
3. Suppression of conductivity (dropotropic effect).
4. Automatism of the cardiovascular system (bathmotropic effect).

Due to the fact that beta blockers block adrenaline receptors, this reduces the myocardial oxygen demand. Due to their blocking ability, these drugs have antiarrhythmic properties.

In addition, they normalize blood pressure, so they are often used in the treatment of hypertension. Blocking B2 adrenergic blockers affects:

1. Increased smooth muscle tone in the bronchi.
2. Contraction of the uterus during pregnancy.
3. Contractile actions in the cells of the gastrointestinal tract (may be accompanied by nausea and diarrhea).

It is worth considering that the drugs in this group affect lipid and carbohydrate metabolism and increase the synthesis of glycogen in the liver.

Instructions for use

The duration of the course of treatment, dosage of drugs and the general treatment regimen are determined by the doctor. In order for therapy to be effective, the general condition of the patient’s body must be taken into account, and whether there are any contraindications is noted.

In addition, regular monitoring of the patient’s condition is carried out. If side effects are detected, the doctor will replace the medications with similar ones.

Throughout treatment, blood pressure and heart rate readings should be monitored. Even with minor deviations from the norm, you should immediately consult a doctor to adjust the treatment.

Stopping beta blockers should occur gradually. Abrupt termination of a course often provokes a withdrawal effect and negative manifestations intensify.

Indications for taking beta-blockers

The main cases in which beta-blockers are prescribed:

• IHD and angina attacks;

BBs reduce the frequency and strength of heart contractions, lower blood pressure

• hypertension with prevention of coronary artery disease;
• prevention of acute myocardial ischemia and coronary syndromes without shock;
• prevention of sudden death in patients with prolonged QT on ECG,
• chronic heart failure;
• increased hormonal activity of the thyroid gland;
• withdrawal syndrome in alcoholism, tremor;
• dissecting aortic aneurysm,
• cardiomyopathy of the hypertrophic type;
• mitral valve stenosis with tachysystole;
• congenital defect - tetralogy of Fallot.

Side effects

In some cases, beta blocker therapy is accompanied by negative side effects:

• feeling of chronic fatigue and increased fatigue;
• disturbance of the rhythm of heart contractions in the direction of slowing down;
• increased asthmatic symptoms;
• intoxication of the body, which is manifested by nausea and accompanying vomiting;
• decrease in blood glucose concentration;
• excessive drop in blood pressure levels;
• pathological changes in metabolic processes;
• increased symptoms of lung diseases;
• impaired concentration;
• dyspeptic disorders of the digestive system;
• decreased sexual desire;
• development of inflammatory processes on the mucous membrane of the eyes;
• allergic rashes over the entire area of ​​the skin;
• circulatory disorders in the extremities.

If side effects occur during therapy with these medications, stop taking the drug. The doctor selects more suitable analogues.

Types of medicines

There are three classifications of this group of drugs, namely:

1. According to the effect on receptors (selective and non-selective).
2. By solubility in the medium (lipophilic and hydrophilic).
3. According to the effect on the autonomic nervous system (with and without sympathomimetic activity).

There is a classification of funds into three generations. The higher the generation of the medicine, the fewer side effects it will cause. But efficiency does not always depend on generation. The specialist focuses on the body’s individual reaction to the drug. It is third generation medications that can relax and dilate blood vessels.

Contraindications

Beta blockers are strictly prohibited for the following concomitant conditions of the body:

• asthma;
• individual intolerance to the components of a particular drug;
• heart rhythm pathology in the form of a decrease in the number of contractions;
• violation of impulse conduction from the atrium to the ventricle;
• insufficient functioning of the left ventricle;
• vascular diseases;
• low blood pressure.

In addition, beta blockers should not be taken during pregnancy or during pregnancy planning.

Drugs that affect the flow of ions through the cardiomyocyte membrane

Sodium channel blockers exert their effect by inhibiting the penetration of sodium ions into the cardiomyocyte. As a result of these actions, excitability decreases and the conduction of impulses through the heart slows down, which leads to a decrease in the manifestations of arrhythmia. This group includes procainamide, quinidine, lidocoine hydrochloride, propafenone.

Calcium channel blockers inhibit the penetration of calcium ions into myocardial cells from the intercellular space. As a result, myocardial conduction slows down, contributing to a decrease in heart rate, and dilation of the coronary vessels occurs.

More often used:

1. diphenylalkylamine derivatives (verapamil, berlipril),
2. benzothiazepine derivatives (diltiazem).

Potassium channel blockers inhibit the penetration of potassium ions into cells. As a result, the automaticity of the sinus node decreases, atrioventricular conduction slows down, which leads to a decrease in the heart rate and dilation of the coronary vessels. Amiodarone and sotalol are used.

Cardiac glycosides are herbal preparations. The effect is achieved by inhibiting the conduction of nerve impulses in the conduction system. Digoxin belongs to the group of glycosides.

Overdose

If beta blockers are taken incorrectly, or the recommended dosage and duration of treatment are exceeded, an overdose may occur. It is accompanied by the following symptomatic manifestations:

• severe dizziness;
• loss of consciousness;
• heart rhythm disturbances;
• a sharp decrease in heart rate;
• blue discoloration of the skin;
• convulsions;
• coma.

If drug poisoning occurs due to an overdose, it is necessary to provide first aid to the victim as soon as possible. It includes:

1. washing the patient's stomach;
2. taking absorbent drugs;
3. emergency medical call.

Depending on the symptoms, the patient may be prescribed different drugs to normalize the condition. In case of heart rhythm disturbances, the victim is given atropine, adrenaline or dopamine, depending on the characteristics of the pathology.

If symptoms of heart failure occur, the victim is given to take diuretics and drugs from the group of glycosides.

Incompatibility with other drugs

When prescribing complex treatment for any disease, three probabilistic lines of drug interaction are possible. So this may be a mutual enhancement of the positive therapeutic effect of both one of the drugs involved in the medical regimen and their overall effect on the body.

1. A neutral, indifferent attitude of drugs to each other during the treatment process is possible.
2. It is possible that the effect of any drugs may be inhibited by other drugs used.
3. Dangerous combinations are possible.

Let's consider such dangerous cases.

• Combination of beta-blockers with antihypertensive drugs of the non-hydropyridone group of calcium channel blockers. Let us remember that these are Verapamil, Nifedipine, Isoptin and similar ones. The use of any of these two classes of drug alone results in a drop in heart rate. Prescription errors are dangerous because the combined effect of calcium channel blockers and adrenergic blockers used together leads to a critical slowdown in heart rate. The only justified case for the need for such a combination is control of the ventricular rhythm against the background of stable inconsistency in the functioning of the heart parts.
• Combination of beta-blockers with centrally acting drugs. The CD group of drugs includes drugs that affect the sympathetic activity of the brain. These are Guanfacine, Clonidine, Methyldopa. The danger is the mutual strengthening of side effects when combining adrenergic blockers with these drugs.

Difference from Alpha blockers

All drugs that inhibit and block the activity of adrenergic receptors are divided into the following groups:

• alpha blockers;
• beta blockers.

Alpha group drugs act on the corresponding receptors. Their influence is aimed at simplifying the process of blood flow, which in turn reduces the level of pressure in the vessels. An additional effect when taking alpha blockers can be considered a decrease in cholesterol levels.

Beta group drugs block the functioning of the corresponding beta receptors. They reduce the intensity of contractions of the heart muscle and lower blood pressure. As an additional effect, auxiliary therapy for cardiac ischemia can be considered.

Latest generation beta blockers

Modern beta blockers of the latest, third generation are represented by a short list of “Celiprolol” and “Carvedilol”.

They have the properties of acting on both beta and alpha adrenergic receptors, which makes them the widest in terms of application and pharmaceutical activity.

Celiprolol

Taken to quickly lower blood pressure. Can be used for a long time.

It also affects the nature of the functional activity of the heart muscle. Prescribed to patients of different age groups.

Carvedilol

Since it can also block alpha receptors, it effectively dilates blood vessels.

It is used not only as part of the treatment of diseases of the cardiovascular system, but also as a prophylactic agent to normalize coronary blood flow, which is absolutely necessary when it comes to preventing a heart attack.

An additional effect of mixed beta blockers is their ability to eliminate extrapyramidal disorders.

Sometimes this action is used to correct deviations when taking antipsychotics. Still, this is extremely risky, therefore Carvedilol has not received widespread use as a medicine to replace Cyclodol and others.

The choice of a specific name or group should be based on the diagnostic results.

Features of the drugs

Hypertension is a disease that often provokes complications such as heart attack and stroke. Numerous medical studies have proven that patients taking blockers have a significantly lower risk of experiencing such consequences of the disease. However, it was noted that the success of this treatment concerns patients of middle age. In older people who do not have coronary heart disease, diuretics and sedatives are more often prescribed. However, in case of complications such as ischemia or stroke, beta blockers are still indicated for elderly patients.

Hypertension is an increase in blood pressure for various reasons. It occurs in the following cases:

• heredity;
• congenital pathologies of the heart and blood vessels;
• stress, emotional stress;
• taking certain medications;
• heart and kidney diseases;
• bad habits;
• sedentary lifestyle;
• malnutrition and others.

All this can lead to hypertension, which is accompanied by very unpleasant symptoms. Patients with high blood pressure (BP) complain of headaches, discomfort and burning in the area of ​​the heart and shoulder blades, dizziness, weakness and irritability, poor sleep and general loss of performance.

Beta blockers help reduce blood pressure and normalize the patient's general condition. Also, these drugs are indicated in the following cases:

• ischemia;
• heart failure;
• thyroid function disorders;
• frequent headaches;
• high blood pressure.

In order to understand exactly how beta blockers work and what they are, we will try to figure out the mechanism of their action on the body.

Everyone knows about the existence of such a hormone as adrenaline. It is produced in stressful situations, during emotional experiences and tension. Its effect on the body is increased arousal and increased heart rate. As a result, blood pressure also increases. Beta blockers were invented to block adrenaline and other similar hormones. The mechanism of action is to “protect” the heart from stimulating hormones.

In case of ischemia and heart rhythm disturbances, these drugs can protect a vital organ and prevent complications of the disease.

Important! It should be remembered that hypertension does not always require treatment with beta blockers. If the increase in pressure is not accompanied by pain in the heart, their use is not justified.