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Beta Blockers Mechanisms of Action Effects on myocardiumSuppression of renin releaseInhibition of presynatic β 1 receptors positivefeebackDecreased central sympathetic outflowCNS effectsReduction in peripheral resistanceImprovement in vascular complianceResetting of baroreceptor levelsAttenuation of pressor response to catecholamines(stress, exercise)
Beta BlockersSide Effects Bronchospasm Bradicardia/heart block Mask and prolong the symptoms of hypoglycemia Abrupt withdrawal can precipitate MI Cold extremities, Raynaud’s phenomenon, intermittent claudication Decreased exercise tolerance; fatigue, depression and impotence CNS: sleep disturbance, vivid dreams, nightmares Effects of plasma lipids
Without Compelling Indications Stage 1 Hypertension Stage 2 Hypertension (SBP 140–159 or DBP 90–99 (SBP >160 or DBP >100 mmHg) mmHg) 2-drug combination for most Thiazide-type diuretics for most. (usually thiazide-type diuretic and May consider ACEI, ARB, BB, CCB, ACEI, or ARB, or BB, or CCB) until goal blood pressure is achieved or combination.Optimize dosages or add additional dru Blood Pressure Not at Goal Initial Drug Choices Lifestyle Modifications as needed. (diuretics, ACEI, ARB, BB, CCB) Not at Goal Blood Pressure (<140/90 mmHg) Other antihypertensive drugs indications Drug(s) for the compelling (<130/80 mmHg for those with diabetes or chronic kidney disease) Indications With Compelling Algorithm for Treatment of Hypertension
Classification of Heart Failure ACC/AHA HF Stage1 NYHA Functional Class2A At high risk for heart failure but without structural heart disease or symptoms of heart failure (eg, patients with hypertension or coronary artery disease) I AsymptomaticB Structural heart disease but without symptoms of heart failure II Symptomatic with moderate exertionC Structural heart disease with prior or current symptoms of heart failure III Symptomatic with minimal exertionD Refractory heart failure requiring IV Symptomatic at rest specialized interventions1 Hunt SA et al. J Am Coll Cardiol. 2001;38:2101–2113.2 New York Heart Association/Little Brown and Company, 1964. Adapted from: Farrell MH et al. JAMA. 2002;287:890–897.
Stages of Heart Failure and Treatment Options for Systolic Heart FailureJessup, M. et al. N Engl J Med 2003;348:2007-2018