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Multicenter Study
. 2011 Dec;34(12):748-54.
doi: 10.1002/clc.20981. Epub 2011 Nov 14.

Differential effect of β-blockers for heart rate control in coronary artery disease

Alberto Cordero  1 , Vicente Bertomeu-González, Pilar Mazón, José Moreno-Arribas, Lorenzo Fácila, Héctor Bueno, Jose R González-Juanatey, Vicente Bertomeu-Martínez
Affiliations
Multicenter Study

Differential effect of β-blockers for heart rate control in coronary artery disease

Alberto Cordero et al. Clin Cardiol. 2011 Dec.

Abstract

Background: Resting heart rate is an independent risk factor for cardiovascular disease and is mainly controlled by β-blockers (BBs). BBs are part of the optimal medical treatment for coronary artery disease (CAD), and their benefit correlates with resting heart rate (RHR) reduction.

Hypothesis: RHR is poorly controlled in daily practice among patients with stable cardiovascular disease, and control is only achieved by some BBs.

Methods: Observational, cross-sectional, and multicenter study of CAD patients recruited nationwide from 20 institutions. Antecedents, risk factors, and treatments were collected. Controlled RHR was considered at <70 bpm.

Results: The mean age of the 2897 patients included was 67.4 years (11.4%), and 75.9% were males. Patients treated with a BB (56.5%) had a lower mean age and comorbidities. The mean RHR was 69.6 bpm (12.6). A significantly lower RHR was observed in patients treated with a BB compared to the rest (67.2 vs 73.0 bpm; P<0.01), and no difference was observed in patients treated with a calciumchannel blocker (CCB). The analysis by individual agents identified that only patients treated with atenolol, bisoprolol, and metoprolol had significantly lower RHR than those not receiving a BB. No differences were observed in mean doses of each agent according to RHR control, except for verapamil. BB treatment was independently associated with RHR control (odds ratio [OR]: 2.42, 95% CI: 2.05-2.87; P<0.01), and no association was found for nondihydropyridine CCBs (OR: 0.99, 95% CI: 0.96-1.02; P = 0.38). Bisoprolol (OR: 1.56, 95% CI: 1.38-1.78; P<0.01), atenolol (OR: 2.01, 95% CI: 1.57-3.49; P<0.01), and metoprolol (OR: 1.29, 95% CI: 1.04-1618; P = 0.04) were independently associated with RHR control.

Conclusions: RHR is poorly controlled in CAD patients, and although BBs are the most efficient therapy, in daily clinical practice RHR <70 bpm is only independently associated with atenolol, bisoprolol, or metoprolol.

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Figures

Figure 1
Figure 1
Mean resting heart rate (RHR) observed in patients treated with a β‐blocker (BB), nondihydropyridine calcium channel blocker (CCB), both, or none of them.
Figure 2
Figure 2
Mean resting heart rate in patients treated with each β‐blocker or none of them.
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