•DIMITRI RICHTER, MD, FESC, FAHA

•Head of Cardiac Dept.,Euroclinic Hosp, Athens

•General Secretary of the Hellenic Lipidology Society

Are all b-blockers the same?

ΒηταξολόληΒηταξολόλη--ββ11((KerloneKerlone))

ΝεμπιβολόληΝεμπιβολόλη--vdvd((LobivonLobivon))

ΣελιπρολόληΣελιπρολόλη--ββ1+1+ISAISA((SelectolSelectol))

11

--selectivity of various selectivity of various --blockersblockers

Fig. 1Fig. 1--4 Effects of 4 Effects of --blockers with/without ISAblockers with/without ISA

Effects of Effects of --blockers with/without ISA on pulse intervalblockers with/without ISA on pulse interval

Table 3Table 3--55

–16.5

–12.4

–14.2

–9.9

–12.2–10.9

–13.2

–8.9

p = 0.03

0

–5

–10

–15

–20

day(6 a.m. –

10 p.m.) (6 a.m. –

noon)night

(10 p.m. –

6 a.m.)last 4 hours

of dosing interval(6 a.m. –

10 a.m.)

p = 0.03

p = 0.54p <0.05

mea

n ch

ange

in s

ysto

lic b

lood

pre

ssur

e (m

m H

g)

Atenolol (n = 96)

Bisoprolol (n = 107)

Bisoprolol: Treatment of hypertension in comparison to atenolol

Bisoprolol: Treatment of hypertension in comparison to atenolol

Neu

tel J

M e

t al.

Am J

Med

199

3; 9

4:18

1–18

7

± SEMx

64%58%

80%

p < 0.05

52%

Success rates in smokers after 8 weeks treatment

non-smokers (n = 69) smokers (n = 25)

%

Bisoprolol 10 –

20 mg

80

60

40

20

≤95

mm

Hg

Atenolol 50 –

100 mg

Bisoprolol: Treatment of hypertension in smokers in comparison to atenolol

Bisoprolol: Treatment of hypertension in smokers in comparison to atenolol

Bühl

er F

et a

l. J

Hyp

erte

ns 1

986;

4 (S

uppl

. 6):

144–

146

National Cholesterol Education Program Expert Panel on DetectionNational Cholesterol Education Program Expert Panel on Detection, Evaluation, , Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatmeand Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)nt Panel III)

HDL-cholesteroltotal cholesterol

5 years4 years3 years2 years1 yearstart

mmol/l

0

1

2

3

4

5

6

7

8

LDL-cholesteroltriglycerides

Bisoprolol: ß1

-selectivity and lipid metabolism in long-term therapy

Bisoprolol: ß1

-selectivity and lipid metabolism in long-term therapy

Frith

z G

. 5th

Inte

rnat

Sym

posi

um o

n C

ardi

ovas

cula

r Pha

rmac

othe

rapy

,M

inne

apol

is, A

bstra

ct 1

993

N N EnglEngl J Med 2000;342:905J Med 2000;342:905--12.12.

Table 3Table 3--99

…………..ββ--blockers may worsen insulin resistance and may blockers may worsen insulin resistance and may mask symptoms of hyperglycemia; even so, they are mask symptoms of hyperglycemia; even so, they are generally well tolerated by patients with diabetes and generally well tolerated by patients with diabetes and are indicated in those with recent myocardial infarction. are indicated in those with recent myocardial infarction. Moreover, in the United Kingdom Prospective Diabetes Moreover, in the United Kingdom Prospective Diabetes Study (UKPDS),16 Study (UKPDS),16 ββ--blockers rivaled ACE inhibitors in blockers rivaled ACE inhibitors in overall efficacy for prevention of diabetic overall efficacy for prevention of diabetic complications.complications.

Circulation 2002;105:e153Circulation 2002;105:e153--e158.e158.

GotliebGotlieb SS, et al.SS, et al. EFFECT OF BETAEFFECT OF BETA--BLOCKADE ON BLOCKADE ON MORTALITY AMONG HIGHMORTALITY AMONG HIGH--RISK AND LOWRISK AND LOW--RISK RISK

PATIENTS AFTER MYOCARDIAL INFARCTIONPATIENTS AFTER MYOCARDIAL INFARCTION. N Eng J . N Eng J Med 1998;339:489Med 1998;339:489--97.97.

COPDCOPDCOPD pts. presented 40% lower death rate when prescribed b-blockers. Pts. With asthma benefited also from b- blockers..

Figure 2: Adjusted Probability of Survival among Patients with or without a History of Chronic Chronic Obstructive Pulmonary Disease (COPD)Obstructive Pulmonary Disease (COPD) Who Received or Did Not Receive Beta-Blockers.

Fig. 6Fig. 6--8 Effects of 8 Effects of bisoprololbisoprolol

and and atenololatenolol

on airway resistance on airway resistance and heart rate in patients with COPDand heart rate in patients with COPD

Fig. 6Fig. 6--9 Effects of 9 Effects of bisoprololbisoprolol

and and atenololatenolol

on airway resistance on airway resistance in hypertensive patients with bronchial asthmain hypertensive patients with bronchial asthma

Fig. 2Fig. 2--16 Effects of 16 Effects of perioperativeperioperative

--blocker therapy on mortality blocker therapy on mortality and MI in patients undergoing nonand MI in patients undergoing non--cardiac surgerycardiac surgery

CIBIS III Study: effect of CIBIS III Study: effect of bisoprololbisoprolol--first vs. first vs. enalaprilenalapril-- first on sudden deathfirst on sudden death

Effects of Effects of --blockers on allblockers on all--cause mortality in CHFcause mortality in CHF

The The ““Hawthorne effectHawthorne effect””

BradycardiaBradycardia

and band b--blockersblockers

««Life starts with the first heart beat and Life starts with the first heart beat and finishes with the last onefinishes with the last one»»

Aristotle

1001005050

3030

1010

55

22Life

exp

ecta

ncy

(yea

rs)

Life

exp

ecta

ncy

(yea

rs)

BeatsBeats

//

lifetimelifetime101066 101088 10101010 10101212

ManMan

WhaleWhaleHorseHorseElephantElephant LionLion

DogDog CatCatAssAss GiraffeGiraffeMonkeyMonkeyTigerTiger

MarmotMarmot

RatRat

MouseMouseHamsterHamster

Levine et al. 1997Levine et al. 1997

Survival expectancy and total number Survival expectancy and total number of heart rateof heart rate

Which is the survival expectancy of a patient with mean HR of 25Which is the survival expectancy of a patient with mean HR of 25 b/mb/m? ?

1.1.

80 years80 years

2.2.

120 years120 years

3.3.

230 years230 years

ΒΒ--blockersblockers