Pustaka Ilmiah Universitas Padjadjaran

Abstrak

The Role of Beta Blockers in Cardiovascular Disease

It is now possible to intervene at virtually every stage of the cardiovascular continuum, from asymtomatic individuals with risk factors for atherosclerosis, through to patients with end- stage Chronic Heart Failure (CHF). A wide range of interventions are possible, from lifestyle modification through to pharmacological therapies. Such intervention may allow us to prevent or retard the development of symptomatic heart disease and prolong life. Beta blockers (BB) can intervene effectively at many point in the cardiovascular continuum, slowing or interrupting its progression. They play key roles in the management of hypertension, CHF, and myocardial ischemia, not only in angina pectoris and after myocardial infarction, but also in preventing cardiac complications of non-cardiac surgery. However; many physicians appear to be reluctant to use BB in line with current recommendations because of concerns about their safety and tolerability. This prejudice applies particularly to elderly, to patients with concomitant disorders such as Chronic Obstructive Pulmonary Disease(COPD), diabetes, and intermittent caudication and to sexually active men. Both patients and doctors believe erectile dysfunction (ED) to be a common side-effect of BB, however ED was not associted with selective beta blockers. ED is common in patients with cardiovascular disease, regardless of drug treatment. Sexual activity reduced, because of physiological and psychological factors. The risk factors for CAD are identical to those for ED. Much controversy still surrounds this area. In reality, absolute contraindications such as asthma, atrioventricular block, bradycardia, hypotension, and BB intolerance are uncommon. Patients wih COPD, diabetes, peripheral vascular disease and the elderly can be prescribed BB, provided appropriate precautions are taken. Lung function in patients with COPD receiving BB should be carefully monitored, however; as asthma and COPD may coexist. A policy of “start low and go slow” can therefore often avoid problems.