Appraisal of β-Blocker Use in Patients with Cardiovascular Disease and Chronic Obstructive Pulmonary Disease.

Abstract

β-blockers are a fundamental component of cardiovascular disease (CVD) management, while β₂-agonists are used to treat chronic obstructive pulmonary disease (COPD). Current guidelines recommend that these conditions be treated as usual, even when they coexist. However, there have been concerns over COPD exacerbation risk with β-blockers and attenuation of the beneficial effects of β₂-agonists in this comorbid population, leading to β-blocker underuse. Recent evidence suggests that β-blockers, particularly cardioselective β-blockers, do not increase COPD exacerbations, demonstrate good efficacy and safety, and improve survival in patients with COPD after first-time myocardial infarction. In atrial fibrillation with COPD, both cardioselective and nonselective β-blockers may be associated with a lower COPD exacerbation risk than calcium channel blockers, as well as improving outcomes and reducing mortality risk. In this review, we summarize the β-blocker prescribing patterns in patients with CVD and COPD; describe the reasons for β-blocker underuse in patients with CVD with COPD; collate up-to-date evidence on the effects of β-blockers on symptoms and outcomes in each of these comorbid populations; and review the current treatment guidelines for coexisting COPD and CVD to support the rational prescribing of β-blockers. Finally, we provide recommendations for future research needed to demonstrate the clinical rationale of prescribing β-blockers and to encourage the generation of more robust evidence-based guidelines for β-blockers use. Future large-scale, prospective, randomized controlled trials are needed to expand the body of evidence and better understand the effects of β-blockers in CVD with comorbid COPD.