Terapêutica cardiovascular com bloqueadores beta: ponto da situação

Autores

  • Luís Bronze Interno do lnternato Complementar de Cardiologia, Serviço de Cardiologia do Hospital de Santa Cruz, Carnaxide

Palavras-chave:

bloqueadores beta, terapêuti­ca cardiovascular

Resumo

Os bloqueadores fl (b-fl) permanecem agen­tes terapêuticos de grande importância na te­rapêutica cardiovascular. Constituem um gru­po terapêutico vasto, de razoável complexida­de, com novos agentes ainda em desenvolvimen­to e indicações alargadas para agentes já co­nhecidos.

Foram revistas as principais características farmacológicas e farmacocinéticas dos b-fl, com particular ênfase para noções importantes na prática clínica diária: potência, relação estru­tura-actividade, selectividade, actividade sim­ paticomimética intrínseca, capacidade bloque­dora a e variabilidade da relação dose-eficá­cia terapêutica destes fármacos.

As indicações terapêuticas para cada enti­dade foram analisadas, pondo em relevo o efei­to protector de mortalidade dos b-fl em sobre­ viventes de enfarte de miocárdio, a capacidade anti-hipertensora destes agentes, que continu­am a ser agentes de primeira linha no tratamento da hipertensão arterial, e a promissora utili­zação de sotalol - único agente com actividade antiarrítmica de classe III - no tratamento as disritmias. Promissor, também, parece ser o uso de b-fl no tratamento da miocardiopatia dila­ tada.

Finalmente, foram revistos os efeitos adversos e contra-indicações dos fl-b, controvérsias a cerca do seu uso em doentes com diabetes mellitus, doença vascular perifé­rica e no contexto de dislipidémia de particu­lar relevância.

Downloads

Não há dados estatísticos.

Referências

Prichard B N C.Dal -adrenergic receptor blocking drugs in angina pectoris. Drugs 1974; 7: 55-84.

Frishman W H, Sonnenblick E. H. Beta-adrenergic blocking drugs. ln Hurst's the Heart, 8 th international edition, 1994: 1271- 1290.

Frishman WH. Beta-adrenergic blocker Withdrawal. Am J Car­diol 1987; 59: 26F-32F.

Opie LH, Sonnenblick EH, Frishman WH, Thadani U. Beta-blo­cking agents. ln Drugs for the Heart, 4mediton, 1995: 1-30

Parker J O, Porter A, Parker J D. Propanolol in angina pectoris: comparison of long acting and standard formulation propa­nolol. Circulation 1982; 65: 1351-1355.

Leopold G. Balanced pharmacokinetics and metabolism of bi­soprolol. Cardiol Actual, 1994;33: 1160-1161.

Swanton RH. Beta-blocking agents. ln Cardiology pocket con­ sultant, 3'edition, Blackwell Scientific Publications 1994: 169- 172.

Crawford MH. Chronic ischemic heart disease. ln Current Diag­ nosis and Treatment in Cardiology, first edition, 1995: 27-39.

Singh BN, Deedwania P, Nademanee K, Ward A, Sorkin E. Sota­lol: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic use. Drugs 1987; 34:311-349.

Opie LH: Drugs and the heart: Beta-blocking agents. Lancet 1980; 1: 693- 698.

Henry JA, Cassidy SL: Membrane stabilizing activity: a major cause of fatal poisoning. Lancet 1986; 1: 1414-1417.

Frishman WH: multifactorial actions of beta adrenergic blocking drugs in ischemic heart disease: Current concepts. Circulati­on 1983; 67(suppl): 111-118.

Landau AJ, Frishman WH, Alturk N, Adjei-Poku M, Fornasier­ Bongo M, Furia S. Improvement in exercise tolerance and imediate beta-adrenergic blockade with intranasal propano­lol in patients with angina pectoris. Am J Cardiol 1993; 72: 995-998.

Bairey CN, Krantz DS, DeQuattro V, Berman DS, Rozanski A. Effect of beta-blockade on low heart rate-related ischemia during mental stress. J Am Coll Cardiol 1991; 17:1388-1395.

Packer M. Combined beta-adrenergic and calcium entry blo­ckade in angina pectoris. N Eng! J Med 1989; 320 (11): 709-

Hills LD, Lange RA, Wells PJ, Winniford MD, Page LR. Treat­ment of Myocardial Infarction. ln Manual of Clinicai Pro­blems in Cardiology, 5tl' edition, 1995: 146-148.

Pasternak RC, Braunwald E, Sobe! BE. Management of acute myocardial infarction. ln Braunwald Heart Disease, 4th editi­on, 1992:1223-1239 .

ISIS-1 (First lnternational Study of Infarct Survival) Collabora­ tive group. Randomized triai of intravenous atenolol among 16027 cases of suspected acute myocardial infarction. Lancet 1986; 2:57-66.

MIAMI Triai Research Group: Metoprolol in Acute Myocardial Infarction (MIAMI): a randomized placebo-controlled in­ ternational triai. Eur Heart J 1985; 6:199-226.

TIMI-II-B study - Roberts R, Rogers WJ, Mueller HS, et ai, for the TIM! Investigators. Imediate versus deferred -blockade following thrombolytic therapy in patients with acute myo­cardial infarction: results of the Thrombolysis in Myocardial Infarction (TIM!) 11-B study. Circulation 1991; 83: 422-437.

Augusti A, Arnan JM, Laporte R. Clinical trials versus clinical prac­tice in the secondary prevention of myocardial infarction. Eur J Clin Pharm 1994; 46(2): 95-99.

Hlatky MA, Cotugno HE, Mark DB, O'Connor C, Pryor DB. Trends in physician management of uncomplicated acute myocardial infarction, 1970 to 1987, 1988. Am J Cardiol 61:515-518.

Jansen RWMM, Gurwitz JH. Controversies surrounding the use of 8-blockers in older patients with cardiovascular disease. Drugs Aging 1994; 4 (3): 175-183.

Jaffe AS. Acute Myocardial Infarction. ln Current Diagnosis and Treatment in Cardiology, first edition, 1995: 50-86.

Bonow RO, Udelson JE. Left ventricular diastolic function as a cause of of congestive heart failure. Ann Intern Med 1992;117: 502-510.

Shah KS, Zahger D. Unstable angina. ln Current Diagnosis and Treatment in Cardiology, first edition, 1995: 40-49.

Hills LO, Lange RA, Wells PJ, Winniford MD, Page LR Exertional angina pectoris ln Manual of Clinicai Problems in Cardiolo­gy, 5th edition, 1995: 88-90.

Swanton RH. Management of unstable angina. ln Cardiology pocket consultant, 3rd edition, Blackwell Scientific Publicati­ons 1994: 186-189.

Hills LO, Lange RA, Wells PJ, Winniford MO, Page LR Silent Myocardial Ischemia , ln: Manual of Clinical Problems in Cardiology, 5th edition, 1995: 151-152.

Graettinger WF. Systemic hypertension. It Current Diagnosis and Treatment in Cardiology, first edition, 1995: 163-171.

Saunders E, Weir MR, Kong BW, Hollifield J, Gray J, et al. A comparison of the efficacy and safety of a blocker, a caleium channel blocker, anda converting enzyme inhibitor in hyper­tensive blacks. Arch Intern Med 1990; 150:1707-1713.

Kaplan NM. Antypertensive drug therapy. It Braunwald Heart Disease, 4th edition, 1992: 858-874.

Komajda M, Grenevay B, Grosgogeat Y: Long term experience with Tertatolol in Hypertension. Am J Nephrol 1986; 6 (sup­pl 2): 106-112.

Agnes E, Vandermercken C, Prost J F, Safar M E. The Tertato­lol International Multicenter Study (TIMS). Predicting fac­tors of an efficient therapy. Am J Hypert 1989; 2: 296S-302S.

Guery O, Herpin D, Lecasble M, Piron J. Tertatolol in hyper­tension. Long term therapy in 2338 patients. Am J Hypert 1989;2: 289S-295S.

Verbeuren T J, Zonnekeyen L L, ProstJ F, et al. The beta-adre­ no receptor blocker tertatolol causes vasodilatation in the iso­lated perfused vasoconstricted kidney. J Pharmacol Exp Ther 1988;246: 628-634.

Bronze L, Martins D, Morgado F, Adragão P, Bonhorst D, Sea­bra-Gomes R. Orientação do doente com síndrome de Wol­ff-Parkinson-White-a propósito de um caso clínico. Cardiol Actual 1993; 24: 865-875.

Bonhorst D. Fármacos antiarrítmicos: ponto da situação. Rev Port Cardiol 1995; 14(5): 421-429.

ESVEM study - MasonJW for the Electrophysiologic Study Ver­ sus Electrocardiographic Monitoring. A comparison of seven antiarrhythmic drugs in patients with ventricular tachyarrhyth­mias. N Engl J Med 1993; 329: 452-458.

Bonhorst D, Adragão P, Morgado F, Trabulo M, Mesquita A, Seabra-Gomes R. Importância do sotalol no tratamento de disritmias. Rev Port Cardiol 1994; 13 (supl.1):1-27.

Swanton RH. Hypertrophic obstrutive cardiomyopathy. lt Car­diology pocket consultant, 3rd edition, Blackwell Scientific Publications: 145-154.

Hills LO, Lange RA, Wells PJ, Winniford MD, Page RL. Hyper­ trophic Cardiomyopathy. lt Manual of Clinical problems in Cardiology, 5th edition, 1995: 191-193.

Shah P. Hypertrophic Cardiomyopathies. It Current Diagnosis and Treatment in Cardiology, first edition 1995: 172-178.

Heilbrunn SM, Shah P, Bristow MR, Valantine HA, Ginsburg R, Fowler MB. lncreased B -receptor density and improved hemodynamic response to cathecolamine stimulation during long term metropolol therapy in heart failure from dilated cardiomyopathy. Circulation 1989; 79: 483-490.

Waagstein F, Caidahl K, Wallentin !, Bergh C-H, Hjalmarson A. Long -term B-blockade in dilated cardiomyopathy: effects of short and long term metropolol teatment followed by wi­th drawal and readministration of metropolol. Circulation 1989;80:551-563.

CIBIS investigators. A randomized triai of B-blockade in heart failure: the cardiac lnsufficiency Bisoprolol study (CIBIS) Circulation 1994; 90: 1765-1773.

Hills LO, Lange RA, Wells PJ, Winniford MO, Page RL. Dissec­ting Aortic Aneurysm. ln Manual of Clinical Problems in Cardiology, 5th edition, 1995: 498-499.

Wernly J A. Thoracic Aortic Dissection. Current Diagnosis and Treatment in Cardiology 1995: 456-468.

Hills LO, Lange RA, Wells PJ, Winniford MD, Page RL. Torsa­ de de Pointes and congenital long QT syndromes. lt Manual of Clinicai Problems in Cardiology, 5th edition, 1995: 33-34.

Correia MJ, Ribeiro C. As arritmias dos síndromes de QT lon­go. ln Arritmias Cardíacas: aspectos clínicos; editor J. Lopo Tuna, 1993: 311-325.

SI. Taylor SH, Silke B, Lee PS. Intravenous beta-blockade in coro­nary heart disease. N Engl J Med 1982; 306: 631- 635.

Martins C. Actualização das recomendações para uso clínico das provas de esforço. Fármacos e provas de esforço. ln 2ª Reunião sobre recomendações, competências e consensos em Cardiologia. Rev Port Cardiol 1994; 13 (suplemento II): 223-225.

De Blasi A, Lipartiti M. Les Interactions du tertatolol avec les recepteurs beta-adrenérgiques. Ann Med Interne 1987; 138:11-13.

Hiatt WR, Stoll S, Nies AS. Effect of B-adrenergic blockers on the peripheral circulation in patients with peripheral vascu­lar disease. Circulation 1985; 72(6): 1226-1231.

Farmer JA, Gotto AM. Risk Factors for coronary heart disease. ln: Braunwald Heart Disease, 4th edition, 1992:1139-1140.

Rutherford JD, Braunwald E. Beta-adrenoreceptor blocking agents. ln: Braunwald Heart Disease, 4th edition, 1992:1307- 1310

Ahumada GG. Identification of patients who do not require beta antagonists after myocardial infarction. Am J Med 1983; 76: 900-904.

Friedman LM. How do the various beta-blockers compare in type, frequency and severity of their adverse effects1 Circula­tion 1983; 67(11):189 - 190.

Publicado

29-03-1996

Como Citar

1.
Bronze L. Terapêutica cardiovascular com bloqueadores beta: ponto da situação . RPMI [Internet]. 29 de Março de 1996 [citado 22 de Maio de 2024];3(1):31-40. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/2261

Edição

Secção

Artigos de Revisão

Artigos Similares

Também poderá iniciar uma pesquisa avançada de similaridade para este artigo.