Drugs & Aging

, Volume 4, Issue 3, pp 175–183 | Cite as

Controversies Surrounding the Use of β-Blockers in Older Patients with Cardiovascular Disease

  • Rene W. M. M. Jansen
  • Jerry H. Gurwitz
Leading Article


Congestive Heart Failure Acute Myocardial Infarction Diastolic Dysfunction Blocker Therapy Xamoterol 
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  1. Alderman J, Grossman W. Are β-adrenergic-blocking drugs useful in the treatment of dilated cardiomyopathy? Circulation 71: 854–857, 1985PubMedCrossRefGoogle Scholar
  2. Anderson JL, Lutz JR, Gilbert EM, et al. A randomized trial of low-dose beta-blockade therapy for idiopathic dilated cardiomyopathy. American Journal of Cardiology 55: 471–475, 1985PubMedCrossRefGoogle Scholar
  3. Andersson B, Blomstrom-Lundqvist C, Hedner T, et al. Exercise hemodynamics and myocardial metabolism during long-term beta-adrenergic blockade in severe heart failure. Journal of the American College of Cardiology 18: 1059–1066, 1991PubMedCrossRefGoogle Scholar
  4. Avorn J, Everitt DE, Weiss S. Increased antidepressant use in patients prescribed β-blockers. Journal of the American Medical Association 255: 357–360, 1986PubMedCrossRefGoogle Scholar
  5. Bansal S. Sexual dysfunction in hypertensive men; a critical review of the literature. Hypertension 12: 1–10, 1988PubMedCrossRefGoogle Scholar
  6. Beta-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. 1. Mortality results. Journal of the American Medical Association 247: 1707–1714, 1982CrossRefGoogle Scholar
  7. Blumenthal JA, Madden DJ, Krantz DS, et al. Short-term behavioral effects of beta-adrenergic medications in men with mild hypertension. Clinical Pharmacology and Therapeutics 43: 429–435, 1988PubMedCrossRefGoogle Scholar
  8. Bonow RO, Udelson JE. Left ventricular diastolic dysfunction as a cause of congestive heart failure. Annals of Internal Medicine 117: 502–510, 1992PubMedGoogle Scholar
  9. Bright RA, Everitt DE. β-Blockers and depression. Evidence against an association. Journal of the American Medical Association 267: 1783–1787, 1992PubMedCrossRefGoogle Scholar
  10. Chadda K, Goldstein S, Byington R, et al. Effect of propranolol after acute myocardial infarction in patients with congestive heart failure. Circulation 73: 503–510, 1986PubMedCrossRefGoogle Scholar
  11. Cohn JN, Levine TB, Olivari MJ, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. New England Journal of Medicine 311: 819–823, 1984PubMedCrossRefGoogle Scholar
  12. Croog SH, Levine S, Testa MA, et al. The effects of antihypertensive therapy on the quality of life. New England Journal of Medicine 314: 1657–1664, 1986PubMedCrossRefGoogle Scholar
  13. Dimsdale JE, Newton RP, Joist T. Neuropsychological side effects of β-blockers. Archives of Internal Medicine 149: 514–525, 1989PubMedCrossRefGoogle Scholar
  14. Eichhorn EJ. The paradox of β-adrenergic blockade for the management of congestive heart failure. American Journal of Medicine 92: 527–538, 1992PubMedCrossRefGoogle Scholar
  15. Evans DA, Funkenstein H, Albert MS, et al. Prevalence of Alzheimer’s disease in a community population of older persons; higher than previously reported. Journal of the American Medical Association 262: 2551–2556, 1989PubMedCrossRefGoogle Scholar
  16. Ferguson DW. Sympathetic mechanisms in heart failure; pathophysiological and pharmacological implications. Circulation 87(Suppl. VII): 68–75, 1993Google Scholar
  17. Forman DE, Gutierrez Bernai JL, Wei JY. Management of acute myocardial infarction in the very elderly. American Journal of Medicine 93: 315–326, 1992PubMedCrossRefGoogle Scholar
  18. Forman DE, Wei JY. Beta-blockers in older patients with myocardial infarction. Journal of the American Medical Association 266: 2222, 1991PubMedCrossRefGoogle Scholar
  19. Francis GS, Benedict C, Johnstone DE, for the SOLVD Investigators. Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the studies of left ventricular dysfunction. Circulation 82: 1724–1729, 1990PubMedCrossRefGoogle Scholar
  20. Gengo FM, Fagan SC, de Padova A, et al. The effect of β-blockers on mental performance on older hypertensive patients. Archives of Internal Medicine 148: 779–784, 1988PubMedCrossRefGoogle Scholar
  21. Goldberg RJ, Gore JM, Gurwitz JH, et al. The impact of age on the incidence and prognosis of initial acute myocardial infarction: the Worcester heart attack study. American Heart Journal 117: 543–549, 1989PubMedCrossRefGoogle Scholar
  22. Goldbourt U, Behar S, Reicher-Reiss H, et al. Early administration of nifedipine in suspected acute myocardial infarction: the secondary prevention reinfarction Israel nifedipine trial 2 study. Archives of Internal Medicine 153: 345–353, 1993PubMedCrossRefGoogle Scholar
  23. Goldstein G, Materson BJ, Cushman WC, et al. Treatment of hypertension in the elderly: II. Cognitive and behavioral function. Hypertension 15: 361–369, 1990PubMedCrossRefGoogle Scholar
  24. Grossman W. Diastolic dysfunction in congestive heart failure. New England Journal of Medicine 325: 1557–1564, 1991PubMedCrossRefGoogle Scholar
  25. Guralnik JM, Land KC, Blazer D, et al. Educational status and active life expectancy among older blacks and whites. New England Journal of Medicine 329: 110–116, 1993PubMedCrossRefGoogle Scholar
  26. Gurwitz JH, Avorn J. The ambiguous relation between aging and adverse drug reactions. Annals of Internal Medicine 114: 956–966, 1991PubMedGoogle Scholar
  27. Gurwitz JH, Col NF, Avorn J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction. Journal of the American Medical Association 268: 1417–1422, 1992PubMedCrossRefGoogle Scholar
  28. Gurwitz JH, Goldberg RJ, Chen Z, et al. β-Blocker therapy in acute myocardial infarction: evidence for underutilization in the elderly. American Journal of Medicine 93: 605–610, 1992PubMedCrossRefGoogle Scholar
  29. Hjalmarson A, Herlitz J, Holmberg S, et al. The Göteborg Metoprolol Trial. Effects on mortality and morbidity in acute myocardial infarction. Circulation 67(Suppl. I): 26–32, 1983Google Scholar
  30. ISIS-1 Collaborative Group. Randomized trial of intravenous atenolol among 16027 cases of suspected acute myocardial infarction. Lancet 2: 57–65, 1986Google Scholar
  31. Jessup M. Beta-adrenergic blockade in congestive heart failure: answering the old questions. Journal of the American College of Cardiology 18: 1067–1069, 1991PubMedCrossRefGoogle Scholar
  32. Kostis JB, Rosen RC. Central nervous system effects of β-adrenergic blocking drugs: the role of ancillary properties. Circulation 75: 204–212, 1987PubMedCrossRefGoogle Scholar
  33. Lichstein E, Hager WD, Gregory JJ, et al. Relation between beta-adrenergic blocker use, various correlates of left ventricular function and the chance of developing congestive heart failure. Journal of the American College of Cardiology 16: 1327–1332, 1990PubMedCrossRefGoogle Scholar
  34. Luchi RJ, Snow E, Luchi JM, et al. Left ventricular function in hospitalized geriatric patients. Journal of the American Geriatrics Society 30: 700–705, 1982PubMedGoogle Scholar
  35. Luchi RJ, Taffet GE, Teasdale TA. Congestive heart failure in the elderly. Journal of the American Geriatrics Society 39: 810–825, 1991PubMedGoogle Scholar
  36. MIAMI Trial Research Group. Metoprolol in acute myocardial infarction (MIAMI). A randomized placebo-controlled international trial. European Heart Journal 6: 199–226, 1985Google Scholar
  37. Montague TJ, Ikuta RM, Wong RY, et al. Comparison of risk and patterns of practice in patients older and younger than 70 years with acute myocardial infarction in a two year period (1987–1989). American Journal of Cardiology 68: 843–847, 1991PubMedCrossRefGoogle Scholar
  38. NIH Consensus Development Panel on Impotence. Impotence. Journal of the American Medical Association 270: 83–90, 1993CrossRefGoogle Scholar
  39. Norwegian Multicenter Study Group. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. New England Journal of Medicine 304: 801–807, 1981CrossRefGoogle Scholar
  40. Packer M, Hung Lee W, Kessler PD, et al. Role of neurohormonal mechanisms in determining survival in patients with severe chronic heart failure. Circulation 75(Suppl. IV): 80–92, 1987Google Scholar
  41. Radack K, Deck C. β-Adrenergic blocker therapy does not worsen intermittent claudication in subjects with peripheral arterial disease; a meta-analysis of randomized controlled trials. Archives of Internal Medicine 151: 1769–1776, 1991PubMedCrossRefGoogle Scholar
  42. Rich MW, Bosner MS, Chung MK, et al. Is age an independent predictor of early and late mortality in patients with acute myocardial infarction? American Journal of Medicine 92: 7–13, 1992PubMedCrossRefGoogle Scholar
  43. Skinner MH, Futterman A, Morrissette D, et al. Atenolol compared with nifedipine; effect on cognitive function and mood in elderly hypertensive patients. Annals of Internal Medicine 116: 615–623, 1992PubMedGoogle Scholar
  44. Smith SC, Gilpin E, Ahnve S, et al. Outlook after acute myocardial infarction in the very elderly compared with that in patients aged 65 to 75 years. Journal of the American College of Cardiology 16: 784–792, 1990PubMedCrossRefGoogle Scholar
  45. Solomon S, Hotchkiss E, Saravay SM, et al. Impairment of memory function by antihypertensive medication. Archives of General Psychiatry 40: 1109–1112, 1983PubMedCrossRefGoogle Scholar
  46. Swedberg K, Waagstein F, Hjalmarson A, et al. Prolongation of survival in congestive cardiomyopathy by beta receptor blockade. Lancet 1: 1374–1376, 1979PubMedCrossRefGoogle Scholar
  47. Thiessen BQ, Wallace SM, Blackburn JL, et al. Increased prescribing of antidepressants subsequent to β-blocker therapy. Archives of Internal Medicine 150: 2286–2290, 1990PubMedCrossRefGoogle Scholar
  48. Waagstein F, Hjalmarson A, Wasir HS. Apex cardiogram and systolic time intervals in acute myocardial infarction and effects of practolol. British Heart Journal 36: 1109–1121, 1974PubMedCrossRefGoogle Scholar
  49. Waal HJ. Propranolol-induced depression. British Medical Journal II: 50, 1967CrossRefGoogle Scholar
  50. Wei JY. Age and the cardiovascular system. New England Journal of Medicine 327: 1735–1739, 1992PubMedCrossRefGoogle Scholar
  51. Xamoterol in Severe Heart Failure Study Group. Xamoterol in severe heart failure. Lancet 336: 1–6, 1990CrossRefGoogle Scholar
  52. Yusuf S, Peto R, Lewis J, et al. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Progress in Cardiovascular Diseases 27: 335–371, 1985PubMedCrossRefGoogle Scholar
  53. Yusuf S, Sleight P, Held P, et al. Routine medical management of acute myocardial infarction. Lessons from overviews of recent randomized controlled trials. Circulation 82(Suppl. II): 117–134, 1990Google Scholar
  54. Yusuf S, Wittes J, Friedman L. Overview of results of randomized clinical trials in heart disease. 1. Treatments following myocardial infarction. Journal of the American Medical Association 260: 2088–2093, 1988PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1994

Authors and Affiliations

  • Rene W. M. M. Jansen
    • 1
    • 2
    • 3
  • Jerry H. Gurwitz
    • 2
    • 4
    • 5
  1. 1.Department of Medicine, Division of GerontologyBeth Israel HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Hebrew Rehabilitation Center for AgedBostonUSA
  4. 4.Program for the Analysis of Clinical Strategies, Division of Gerontology, Department of MedicineBrigham and Women’s HospitalBostonUSA
  5. 5.Brockton/West Roxbury Veterans Affairs Medical CenterWest RoxburyUSA

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