Beta Blockers in Heart Failure: More Evidence for an Old Friend

다국어 초록 (Multilingual Abstract)

High resting heart rate (≥ 70 bpm) was common in heart failure with reduced ejection fraction (HFrEF; ejection fraction ≤ 35%) patients and is associated with adverse outcomes in a real-world analysis. For heart failure (HF) hospitalization, hazard appeared to be more closely associated with heart rate rather than β-blocker dose.1 Chronic β1-adrenergic receptor overactivation is well known to be an important component of pathologic ventricular remodeling, and evidence-based β-blockers are a clinically effective treatment of HFrEF owing in part to their reverse-remodeling effect. Current HF guidelines recommend the use of β-blockers based on many randomized controlled trials showing a reduced mortality rate > 35%. Although the beneficial effect of β-blocker seems undisputed, whether the target heart rate or target dose is more important in β-blocker therapy is the subject of debate. Meta-analysis showed that heart rate should be considered more important than the actual dose when tailoring β-blocker therapy. In particular, the target resting heart rate might be < 70 beats/min in HF patients. The reason why heart rate reduction is more important than β-blocker dose might be related to the large pharmacogenomic heterogeneity of β-blockers.2

참고문헌 (Reference)

1 Lupon J, "Prediction of survival and magnitude of reverse remodeling using the ST2-R2 score in heart failure: A multicenter study" 204 : 242-247, 2016

2 Lee HY, "Optimal use of beta-blockers for congestive heart failure" 80 (80): 565-571, 2016

3 Sucharov CC, "Myocardial microRNAs associated with reverse remodeling in human heart failure" 2 (2): e89169-, 2017

4 Hae-Young Lee, "Impact of the β-1 adrenergic receptor polymorphism on tolerability and efficacy of bisoprolol therapy in Korean heart failure patients: association between β adrenergic receptor polymorphism and bisoprolol therapy in heart failure (ABBA) study" 대한내과학회 31 (31): 277-287, 2016

5 최석원, "Impact of Heart Rate Reduction with Maximal Tolerable Dose of Bisoprolol on Left Ventricular Reverse Remodeling" 대한의학회 33 (33): 1-11, 2018

6 Ibrahim N, "Heart rate, beta-blocker use, and outcomes of heart failure with reduced ejection fraction" 2018