"BETA" principle: How coronary heart disease patients use beta blockers

beta blockers have been shown to reduce the risk of all-cause dying and cardiovascular death in patients with non-contraindication-free coronary heart diseaseAuthoritative guidelines at home and abroad consistently recommend that beta blockers can be used as a first-line or preferred drug for patients with coronary heart disease with no contraindications for acute coronary artery syndrome (ACS), stable coronary heart disease (SCAD), and combined heart failure, hypertension, arrhythmia and diabetesHow to apply beta blockers in patients with coronary heart disease? Recently released "the application of beta epinephrine receptor blocker standard treatment of coronary heart disease" of the Chinese expert consensus put forward the "BETA" principle, for different patients to use beta blockers of the clinical indications, usage, treatment objectives and treatment programs to give clear recommendationsConsensus Summary(1) beta blockers are widely used in the prevention and treatment of coronary heart disease, and are the cornerstone of the treatment of PATIENTs with ACS and SCAD(2) beta blockers for patients with coronary heart disease follow the "BETA" principle, namely, Beneficial assessment(benefit assessment), Eindosage (full application), Time EEIng (timely use), and full titration(3) if there is no contraindication, recommended ACS patients admitted to the hospital within 24 h oral beta blocker, or as appropriate intravenous use, should be daily assessment of blood pressure, heart rate, combined with ischemic symptoms and heart function, in the premise of not less than the target heart rate, to the target dose or the maximum tolerable dose of the patient(4) diabetes, COPD, etcare not the taboo evidence applied by beta blockers in patients with coronary heart disease, all SCAD patients, especially labor-type angina patients should use beta blockers as the initial treatment(5) beta blockers should be long-term medication, is one of the basic drugs for secondary prevention of coronary heart disease(6) If coronary heart disease patients fail to reach the target of titration during hospitalization, after discharge from the hospital should continue titration in the clinic, it is recommended that patients regularly monitor blood pressure and heart rate at homeThe main point stake in the use of beta blockers in patients with ACS1ST segment elevated myocardial infarction (STEMI)if there is no contraindication, hemodynamic stability, should be applied as soon as possible (in admission 24 h) beta blockerdaily assessment of blood pressure, heart rate, etc., combined with ischemic symptom synopsis and heart function, in the premise of not less than the target heart rate, as soon as possible titration to the target dose or maximum tolerance dose
dose should be the target dose 55 to 60 times / minute if the hospital failure to achieve the titration target, after discharge should continue to titration in the clinic, it is recommended that patients regularly monitor blood pressure and heart rate at home long-term medication, is one of the basic drugs for coronary heart disease secondary prevention (1) clinical application recommendations and principles all STEMI patients are high-risk groups, secondary prevention intervention Recommends that STEMI patients use beta blockers in ambulances or emergency rooms in a timely manner after assessment of contraindications and clinical synthesis, and apply beta blockers as early as possible (within 24 h of admission) , if there is no clear taboo, it is recommended to be treated with beta blockers for a long time (2) Notes For STEMI patients with clear contraindications, hemodynamic instability or high risk factors of progressive cardiocardial shock (e.g 70 years old, hessy pressure 120 mmHg, heart rate and 110 times/min and other low-heart discharge performance), the application of intravenous beta blockers should be avoided, and oral treatment is recommended after stable condition the titration process of oral beta blockers also needs to be considered for individual treatment In the process of dose titration combined with pulmonary bruising, arrhythmia type and other comprehensive consideration, monitoring heart rate in the premise of not less than the target heart rate, from the small dose gradually ditrates to the target dose or maximum tolerable dose and long-term application because beta blockers can prolong the chamber junction period, acute lower wall myocardial infarction patients should be used with caution some STEMI patients will have new sinus tatters, usually self-limiting, no special treatment required, but before the titage subsides, the need to suspend the application of beta blockers If severe sinusal tasty is mild with symptoms or hemodynamic instability, consideration should be given to using atrotoin or temporary pacing therapy to re-evaluate the application of beta blockers after correction 2 Non-ST segment elevated acute coronary artery syndrome (NSTE-ACS) Patients with frequent angina attacks, restive chest pain, hyperactivity, high blood pressure may consider intravenous application
Other with STEMI parts clinical applicationrecommended with STEMI patients, see table 3 the main principles of clinical application with STEMI, should start from a small dose of medication, titration to the target dose or the maximum tolerable dose of the patient, after the acute period of long-term use the key points of using beta blockers in patients with of coronary heart disease
All Patients with SCAD, especially in labor-type angina patients, should use beta-blockers as an initial treatment and long-term treatment Patients with myocardial infarction or low left ventricular function should be Preferred beta blocker treatment if the patient is tolerated, adjust the dose of beta blocker to control resting heart rate at 55 to 60 times/min
as long as there is no contraindication, beta blocker should be used as the initial treatment of SCAD patients Compared with CCB, beta blockers are more effective in controlling angina and reducing cardiovascular events, can control angina seizures caused by exercise, improve exercise tolerance, reduce symptomatic and asymptomatic myochemtic events, and reduce mortality in patients with myocardial infarction and heart failure, which is the cornerstone of treatment sCAD recommend all SCAD patients, especially labor-type angina patients, as long as there is no contraindication, should use beta blockers as the initial treatment, with aging myocardial infarction, heart failure or hypertension should be preferred to use, in order to control myocardial ischemia, prevent myocardial infarction and improve survival rate If beta blockers are taboo or intolerant, CCB-type drugs or nitrate drugs are available current clinically more likely to use selective beta-1 blockers, such as metorol reprieve synods and solool Clinical applications of beta blockers in SCAD patients are recommended in Table 4 The main principles are related to STEMI and NSTE-ACS Individualized dose start, if the patient can tolerate, gradually increase to the target dose or maximum tolerable dose, so that resting heart rate control at 55 to 60 times / minute guidelines emphasize that beta-blockers should be applied in sufficient, long-term, and emphasize dose management Long-term use of the stability angina relief period beta blocker, it is recommended to implement layered management: (1) ACS with left ventricular blood score (LVEF) and other high-risk groups, recommended beta blocker long-term treatment
; the main points of using beta blockers in patients with microvascular angina Beta blockers are first-line treatments for microvascular angina
microvascular angina (MVA) treatments currently lack large-scale randomized clinical research evidence, so it is recommended to start with classic anti-ischemic drugs, including beta-blockers, CCB and short-acting nitrate drugs If symptoms persist, can be combined with second-line drugs such as Reynolds, Nicotir, Valabredin, long-acting nitrate drugs and angiotensin-converting enzyme inhibitors (ACEI) beta blockers can be applied in combination with nitrite drugs to suppress the reflexive tachycardia and contraction of the pressure receptor-mediated by nitrite drugs Nitrate drugs can expand venous capacity, offset the increase in the late volume of left ventricular diaphthia mediated by beta blockers, and also expand coronary arteries, reducing the coronary artery vascular tension that beta-blockers may cause beta blockers can also be combined with dihydroquine calcium antagonists to reduce the reflexive titcardi over-the-counter caused by the latter Dihydroquinone calcium antagonists can reduce the increase in coronary artery vascular tension that beta blockers may cause The combination of beta blockers and non-dihydroquine calcium antagonists has a potential risk of severe cardiac suppression and should be carefully applied How do select a beta blocker titration target? 1 Target dose the target dose of common beta blockers can be seen in table 2 The blood concentration of mitolol reprieve sofor is more stable and the heart rate control of patients is more stable and long lasting compared to mitolor 2 The target heart rate is 55 to 60 times/min
target heart rate of 55 to 60 times / minute should be as one of the important therapeutic observation indicators It is recommended that the target dose should be used as the target of beta blocker dose titration, and resting heart rate as one of the reference indicators for effective inhibition of sympathetic nerve activation and drug safety Titrate to the target dose or maximum tolerable dose as soon as possible, subject to the heart rate of the target, which is not lower than the target heart rate If the resting heart rate is significantly lower than the target heart rate, or the patient is intolerant of the dose, the dose reduction is required to avoid a tit-down when measuring heart rate: (1) after the morning natural wake (without alarm clock), before getting up, to take the average for three consecutive days is the most ideal; (2) can also be measured at any time of the day, sitting or sitting for 10 minutes, (3) by the electrocardiogram to obtain heart rate as the first choice, but also by touching the pulse (in the case of absolute lysing, such as atrial fibrillation and contraction before frequency), cardiac hearing count to obtain, (4) to avoid excessive interference factors such as temperature, noise and so on The use of automatic blood pressure gauges during home self-tests can also display heart rate values, avoiding the white coat effect However, there are limited studies on the correlation between home self-test heart rate and adverse cardiovascular events The frequency of home self-test heart rate is usually measured 2 times a day morning and evening, taking its mean