Can beta-blockers be “hot”? They have been used for decades in the management of all types of cardiovascular disease, ranging from hypertension to acute myocardial infarction to heart failure. The randomized trials are almost all conducted one or two or even three decades ago.
But, in fact, they are “hot.” Many new and expanded indications for beta-blockade are being investigated and identified. Because tachycardia has been linked to increased mortality across a large spectrum of cardiac and other diseases, use of beta-blockers that would reduce tachycardia makes good pathophysiologic sense. In addition, a simple rule is that if a drug works in one area, it stands a good chance that it will be beneficial in another related area.
In this issue of Hot Topics in Cardiology, Guarracino and Tritapepe provide an up-to-the-minute review of the use of beta-blockers and the importance of heart rate control in the perioperative and surgical intensive care settings. They begin with a review of the many studies linking heart rate to increased complications and mortality, followed by a terrific discussion of the pathophysiology of this link. They then discuss how beta-blockade would provide benefit in the perioperative setting. Finally, they review the current evidence from large observational studies and randomized trials that support the use of beta-blockade. Thus, this review presents much fascinating new data on the use of a very old class of drugs.