Sympathetic Overdrive and Role of Beta-blockers in Various Forms of Heart Failure: A Consensus Statement from India.

Q3 Medicine The Journal of the Association of Physicians of India Pub Date : 2024-11-01 DOI:10.59556/japi.72.0740

H K Chopra, G S Wander, Tiny Nair, C K Ponde, Navin C Nanda, Jagat Narula, Saumitra Ray, K Venugopal, S S Iyengar, R R Kasliwal, Praveen Chandra, Sunil Prakash, Sandeep Bansal, D S Rana, Prafulla Kerkar, Arup Dasbiswas, J P S Sawhney, S Shanmungasundram, Viveka Kumar, I B Vijayalakshmi, A K Pancholia, Vinod Sharma, Aditya Kapoor, H S Isser, Vishal Rastogi, Y K Arora, Ashok K Omar, Sunil Sathe, Rajeeve Rajput, D Prabhakar, G Justin Paul, Priya Jagia, Poonam Malhotra, G Suryaprakash, Vinod Mittal, Manish Jagia, A Jabir, S S Mishra, S N Routray, Ajay Kumar Sinha, Mohan Bhargava, Kiran Mahmood, Mona Bhatia, Pramila Kalra, V K Katyal, Rohit Tandon, Rahul Grover, Abhinav Chhabra, N R Shastry

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Abstract

In heart failure, sympathetic overdrive is evidenced by norepinephrine spillover, receptor level changes, etc. Beta-blockers continue to be the cornerstone of treatment in patients with chronic heart failure due to their ability to counteract sympathetic overdrive. Extensive clinical research has demonstrated that long-term beta-blocker treatment with metoprolol succinate, carvedilol, or bisoprolol enhances left ventricular function and reverses left ventricular remodeling, decreases hospitalization risk, and increases survival. The aim of this consensus paper is to identify patient profiles, initiation or up-titration of beta-blockers and benefits of chirally pure beta-blocker in patients with heart failure. This expert consensus will ensure precise implementation of beta-blockers in heart failure as a part of guideline-directed medical therapy.

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交感神经功能亢进和β-受体阻滞剂在各种心力衰竭中的作用：印度共识声明》。

在心力衰竭中，交感神经过度驱动表现为去甲肾上腺素溢出、受体水平变化等。由于β-受体阻滞剂具有对抗交感神经过度驱动的能力，因此仍然是治疗慢性心力衰竭患者的基石。广泛的临床研究表明，长期使用琥珀酸美托洛尔、卡维地洛或比索洛尔进行β-受体阻滞剂治疗可增强左心室功能、逆转左心室重构、降低住院风险并提高存活率。本共识文件旨在确定心力衰竭患者的基本情况、β-受体阻滞剂的起始或上调剂量以及啁啾纯β-受体阻滞剂的益处。这一专家共识将确保β-受体阻滞剂在心衰患者中的精确应用，并将其作为指南指导下的医疗治疗的一部分。

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