Nonselective beta-blockers in cirrhotic patients with no or small varices:A meta-analysis

AIM:To explore effects of nonselective beta-blockers(NSBBs) in cirrhotic patients with no or small varices.METHODS:The Pub Med,EMBASE,Science Direct,and Cochrane library databases were searched for relevant papers.A meta-analysis was performed using ORs with 95%CI as the effect sizes.Subgroup analysis was conducted according to the studies including patients without varices and those with small varices.RESULTS:Overall,784 papers were initially retrieved from the database searches,of which six randomized controlled trials were included in the meta-analysis.The incidences of large varices development(OR = 1.05,95%CI:0.25-4.36;P = 0.95),first upper gastrointestinal bleeding(OR = 0.59,95%CI:0.24-1.47;P = 0.26),and death(OR = 0.70,95%CI:0.45-1.10;P = 0.12) were similar between NSBB and placebo groups.However,the incidence of adverse events was significantly higher in the NSBB group compared with the placebo group(OR = 3.47,95%CI:1.45-8.33;P = 0.005).The results of subgroup analyses were similar to those of overall analyses.CONCLUSION:The results of this meta-analysis indicate that NSBBs should not be recommended for cirrhotic patients with no or small varices.

Long-term clinical outcome between beta-blocker with ACEI or ARB in patients with NSTEMI who underwent PCI with drug-eluting stents

Background Because limited comparative data are available,we decided to compare 2-year major clinical outcomes between beta-blockers (BB) with angiotensin converting enzyme inhibitors (ACEI) and BB with angiotensin receptor blockers (ARB) therapy in patients with non-ST-segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).Methods A total 11,288 NSTEMI patients who underwent PCI with DES were enrolled and they were divided into two groups,the BB with ACEI group (n = 7600) and the BB with ARB group (n = 3688).The major clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death,recurrent myocardial infarction (re-MI),total revascularization [target lesion revascularization (TLR),target vessel revascularization (TVR),non-TVR] rate during the 2-year follow-up period.Results After propensity score-matched (PSM) analysis,two PSM groups (3317 pairs,n = 6634,C-statistic = 0.695) were generated.Although the cumulative incidences of all-cause death,cardiac death,TLR,and non-TVR were similar between the two groups,MACE (HR = 0.832,95% CI: 0.704?0.982,P = 0.030),total revascularization rate (HR = 0.767,95% CI: 0.598?0.984,P = 0.037),and TVR rate (HR = 0.646,95% CI: 0.470?0.888,P = 0.007) were significantly lower in the BB with ACEI group after PSM.Conclusions In this study,we suggest that the combination of BB with ACEI may be beneficial for reducing the cumulative incidences of MACE,total revascularization rate,and TVR rather than the BB with ARB after PCI with DES in NSTEMI patients.

Beta-blocker therapy in elderly patients with renal dysfunction and heart failure

OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with ejection fraction≤35%and glomerular filtration rate(GFR)≤60 m L/min per 1.73 m^2.We analyzed the relationship between treatment with BB and mortality or cardiovascular events.The mean age of our population was 82.6±4.1 years.Mean ejection fraction was 27.9%±6.5%.GFR was 60-45 m L/min per 1.73 m^2 in 50.3%of patients,45-30 m L/min per 1.73 m^2 in 37.4%,and<30 m L/min per 1.73 m^2 in 12.3%.At the conclusion of follow-up,67.4%of patients were receiving BB.The median follow-up was28.04(IR:19.41-36.67)months.During the study period,211 patients(54.1%)died and 257(65.9%)had a major cardiovascular event(death or hospitalization for heart failure).BB use was significantly associated with a reduced risk of death(HR=0.51,95%CI:0.35-0.74;P<0.001).Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR=30-45 m L/min per 1.73 m^2;HR=0.47,95%CI:0.26-0.86,P<0.0001),stage IIIb(GFR 30-45 m L/min per 1.73 m^2;HR=0.55,95%CI:0.26-1.06,P=0.007),and stages IV and V(GFR<30 m L/min per 1.73 m~2;HR=0.29,95%CI:0.11-0.76;P=0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.

Beta-blockers and physical frailty in patients with endstage liver disease

AIM To investigate beta-blocker(BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.METHODS Adult outpatients with cirrhosis listed for liver transplantation underwent testing of physical frailty using the performance-based Liver Frailty Index, comprised of chair stands, grip strength, and balance testing, as well as self-reported assessments of exhaustion and physical activity. BB use was assessed from medical chart review. Univariable and multivariable logistic regression were performed to determine BB use and their association with measures of physical frailty. Competing risk analyses were performed to determine the effect of BB use on wait-list mortality, as defined by death or delisting for being too sick for transplant.RESULTS Of 344 patients, 35% were female, median age was 60, median model for end stage liver disease was 15, and 53% were prescribed a BB. Compared to those not on BB, patients on BB were similar except for percentage female(25% vs 46%; P < 0.001) and BMI(29 vs 28; P = 0.008). With respect to tests of physical frailty, BB use was not associated with increased odds of frailty(by the Liver Frailty Index), exhaustion, or low physical activity. BB use was, however, significantly associated with a decreased adjusted risk of mortality(SHR 0.55; P = 0.005).CONCLUSION In patients with cirrhosis awaiting liver transplantation, BB use is not associated with physical frailty. We confirmed the known survival benefits with BB use, and concerns about adverse effects should not deter their utilization when indicated.

Beta-blockers and 1-year clinical outcomes in hospitalized heart failure patients with atrial fibrillation

OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)level.METHODS We enrolled hospitalized HF patients with AF from China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study.COX proportional hazard regression models were employed to calculate hazard ratio of betablockers.The primary outcome was all-cause death.RESULTS Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire cohort.There were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite outcome.In the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(<40%),mid-range(40%-49%),or preserved LVEF(≥50%).CONCLUSION Among HF patients with AF,the use of beta-blockers at discharge was not associated with 1-year clinical outcomes,regardless of LVEF.

Is heart rate reduction more important than target dose in chronic heart failure therapy with a beta-blocker?

1 Introduction Beta-adrenoceptor blocking agents(beta-blockers)are now well established as cornerstone therapy in patients with systolic chronic heart failure(CHF).[1]Clinical data have overwhelmingly proven the beneficial effects of beta-blocker therapy in terms of improving patient prognosis,decreasing requirements for hospitalization,and postponing disease progression.[2-4]However,it remains unclear what the optimal efficacious and safe dose for an individual patient with CHF is,and whether this can simply be inferred from the target dose for each beta-blocking agent as used in the major clinical trials.

Discharge heart rate and future events among Japanese patients with acute heart failure receiving beta-blocker therapy

Background: Randomized trials have demonstrated the efficacy of beta-blockers (BBs) in heart failure (HF) patients. We sought to assess the impact of BBs on long-term outcome;in particular, we assessed the association between outcome and BB dose and discharge heart rate. Methods and Results: Prescriptions for dispensed medication and outcomes were identified from a prospective, single-institution HF registry. Long-term prognosis was compared between users and non-users of BBs. BB users were further divided into 2 groups based on dose (full and non-full dose) and discharge heart rate (70 bpm was significantly associated with impaired long-term outcome (HR = 1.872, P = 0.04). Conclusions: Optimizing heart rate, rather than maximizing BB dose, appears to be an appropriate treatment strategy for the beta-sensitive Japanese population.

Analysis of Beta-blockers in Doping Control

A retiabte and sensitive method is developed for the detection of β-blockers which are excreted in free or conjugated forms in human urine.9 β-blockers were derivatized by MSTFA and MBTFA and subjected to GC/MSB analysis.Both chromato- grams and mass spectrometric data were obtained from full scanning mode.This method is suitable for routine screening and confirmation of β-blockers in doping control.

Beta-blocker use and risk of symptomatic bradyarrhythmias： a hospital-based case-control study

在与 -blockers use.MethodsA 的关系调查征兆的 bradyarrhythmias 的风险因素基于医院的盒子控制学习[228 个病人：108 与征兆的 bradyarrhythmias (案例) 和 120 控制] 在 Sultanah Aminah 医院，在 2011 年 1 月之间的马来西亚和 2014 年 1 月 .ResultsThe 平均数年龄里被进行是 61.1 ?? 業牴敩歮?? 呑 ?

Negation of the negation on beta-blockers in patients with cardiovascular diseases and noncardiac surgery

The best protocol of perioperative beta-blockers remains uncertain.Previous studies have demonstrated that tight heart rate control by beta-blockers reduced perioperative myocardial ischemia and improved clinical outcomes.However,the recent studies have failed to provide evidence to support perioperative beta blockers,with potential increased mortality as showed in the POISE trial.In this paper,perioperative use of beta-blockers will be discussed,especially about the evolution of their perioperative therapeutic application and current status.

Heart rate distribution and predictors of resting heart rate after initiation of beta-blocker treatment in patients with coronary artery disease： REsults of Sympathetic Evaluation And Research of China （RESEARCH） study

Background The importance of heart rate as secondary prevention strategies for patients with coronary artery disease （CAD） is emphasized by multiple guidelines. However, limited information is available on the heart rate distribution and the change patterns of resting heart rate when initiating beta-blocker therapy among Chinese patients with CAD. Methods The REsults of Sympathetic Evaluation And Research of China （RESEARCH） study is a multi-centre, prospective, observational study involving 147 centers in 23 cities across China. All eligible beta-blocker naive patients were prescribed with metroprolol succinate. Initial dosage and target heart rate were selected at the discretion of their physicians in charge according to their usual institutional practice. The heart rate distribution and the change patterns of resting heart rate after initiation of beta-blocker therapy were observed. Results The majority of patients （63.6%） were prescribed with 47.5 mg metroprolol succinate. At baseline, there were only 17.4% of patients whose heart rate was less than 70 beats per minute, and the proportion reached 42.5% and 79.1%, one month and two months after initiation of beta-blockers, respectively. Multivariate linear regression analysis showed that baseline heart rate （B=0.900, SE=0.006, t=141.787, P〈0.0001） and the dosage （B=-0.007, SE=0.002, t=-3.242, P=0.001） were independent predictors of resting heart rate 2 months after beta-blocker therapy. Conclusions Resting heart rate is not optimally controlled in a broadly representative cohort of Chinese outpatients with CAD even after initiation of β-blocker therapy, and baseline heart rate and the dosage of beta-blocker are both independent predictors of resting heart rate after β-blocker therapy.

肝硬化门静脉血栓与非选择性β受体阻滞剂的关系及其危险因素探讨

目的 分析肝硬化门静脉血栓(PVT)与非选择性β受体阻滞剂(NSBB)的关系,并了解PVT形成的危险因素及预后情况。方法 收集2016年7月—2019年10月于重庆大学附属中心医院首次诊断PVT的肝硬化患者84例作为PVT组,并选取同期肝硬化不伴PVT的患者90例作为对照组,统计2组住院前、后服用NSBB的情况,比较2组临床资料及预后情况,采用多因素Logistic回归分析PVT形成的危险因素。结果 2组住院前使用NSBB差异无统计学意义(P>0.05),但住院后PVT组使用NSBB比例高于对照组(χ^(2)/P=4.372/0.037)。PVT组患者有腹部手术史、脾切除术及既往内镜治疗比例高于对照组(χ^(2)/P=5.224/0.022、17.154/<0.001、7.992/0.005),血红蛋白水平低于对照组(t/P=3.360/0.001)。多因素Logistic回归分析结果显示,脾切除术、既往内镜治疗是PVT形成的独立危险因素[OR(95%CI)=12.483(2.819~55.284)、2.753(1.319~5.747)],血红蛋白高是其保护因素[OR(95%CI)=0.985(0.975~0.995)]。PVT组发生腹水、消化道出血比例高于对照组(χ^(2)/P=10.618/0.001、21.965/<0.001),但2组病死率比较差异无统计学意义(P>0.05)。结论 使用NSBB是肝硬化进展、门静脉压力增高所致的结果,而非PVT形成的原因。脾切除术、既往内镜治疗、血红蛋白低是PVT形成的高危因素,PVT可增加患者腹水及消化道出血的发生风险。

β受体阻滞剂在中青年高血压中的应用

流行病学数据显示,中青年高血压的患病率约为20%,并逐年上升。这可能与中青年人群工作压力大、精神紧张导致的交感神经兴奋有关,主要表现为以舒张压升高为主。中青年高血压与慢性冠心病或脑卒中明显相关,积极治疗可明显降低患者的长期心血管疾病发生率和死亡风险。β受体阻滞剂通过抑制交感神经活性降低血压,更适用于舒张压升高为主的中青年高血压患病人群。本文通过回顾文献分析了中青年高血压的流行病学数据、潜在机制及临床意义,探讨了β受体阻滞剂在中青年高血压患者管理中的主要作用及应用要点,为临床医生治疗中青年高血压提供参考。

Evolution of care in cirrhosis: Preventing hepatic decompensation through pharmacotherapy

Cirrhosis is a leading cause of morbidity and mortality,impacting more than 120 million people worldwide.Although geographic differences exist,etiologic factors such as alcohol use disorder,chronic viral hepatitis infections,and non-alcoholic fatty liver disease are prevalent in nearly every region.Historically,significant effort has been devoted to modifying these risks to prevent disease progression.Nevertheless,more than 11%of patients with compensated cirrhosis experience hepatic decompensation each year.This transition signifies the most important prognostic factor in the natural history of the disease,corresponding to a decline in median survival to below 2 years.Over the past decade,the need for pharmacotherapies aimed at reducing the risk for hepatic decompensation has been emphasized,and non-selective beta-blockers have emerged as the most effective option to date.However,a critical therapeutic gap still exists,and additional therapies have been proposed,including statins,rifaximin,and sodium-glucose cotransporter-2 inhibitors.Based on the results of innovative retrospective analyses and small-scale prospective trials,these pharmacotherapies represent promising options,but further studies,including randomized controlled trials,are necessary before they can be incorporated into clinical use.This report highlights the potential impact of these agents and others in preventing hepatic decompensation and discusses how this paradigm shift may pave the way for guideline-directed medical therapy in cirrhosis.

健康教育联合沙库巴曲缬沙坦钠片+β受体阻滞剂对老年慢性心力衰竭患者服药依从性及心功能的影响

目的探讨健康教育联合沙库巴曲缬沙坦钠片+β受体阻滞剂对老年慢性心力衰竭(CHF)患者服药依从性、心功能的影响。方法选取2021年10月至2022年12月江苏省中医院收治的老年CHF患者134例进行前瞻性研究。按随机数字表法分成研究组与对照组,每组各67例。对照组采用沙库巴曲缬沙坦钠片+β受体阻滞剂干预,研究组采用健康教育联合沙库巴曲缬沙坦钠片+β受体阻滞剂干预。利用8项Morisky服药依从性量表(MMAS-8)评估两组服药依从性,分别在干预前后采用心力衰竭病人自我管理量表评估患者的自我管理能力,并检测心功能指标,包括左室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)。随访6个月,记录患者心血管不良事件以及再住院发生率。结果研究组服药总依从率为95.52%,高于对照组(85.07%),差异有统计学意义(P<0.05)。两组干预3个月药物管理、心理和社会适应管理、饮食管理、症状管理评分及总分均高于干预前,且研究组各评分分别为(17.39±1.80)、(16.34±1.45)、(9.11±1.06)、(23.36±2.16)、(66.20±7.15)分,均高于对照组[(15.37±1.07)、(14.92±2.33)、(7.93±1.34)、(20.69±3.04)、(58.91±5.33)分],差异均有统计学意义(P<0.05)。两组干预3个月LVEF高于干预前,LVESD、LVEDD均低于治疗前,且研究组LVEF为(42.97±4.71)%,高于对照组[(40.91±2.96)%],差异均有统计学意义(P<0.05),但LVESD、LVEDD比较,差异均无统计学意义(P>0.05)。研究组心血管不良事件、再住院率分别为2.99%、4.48%,与对照组(5.97%、10.45%)比较,差异均无统计学意义(P>0.05)。结论健康教育联合沙库巴曲缬沙坦钠片+β受体阻滞剂干预能提高老年CHF患者的服药依从性及自我管理能力,从而促进LVEF改善,对提升心功能有积极作用。

β受体阻滞剂联合他汀类药物治疗慢性心衰后BNP水平及造血功能的效果

目的研究β受体阻滞剂联合他汀类药物对慢性心衰的治疗效果,评价BNP水平及造血功能变化。方法选择2019年11月—2021年12月本院收治的120例慢性心力衰竭患者为研究对象,通过随机数列法分为治疗组与对照组两组,每组各60例。两组均予以血管紧张素、利尿、低流量吸氧、纠正水电解质、酸解、强心等基础治疗,其中对照组给予β受体阻滞剂(酒石酸托美洛尔,12.5 mg/次,2次/d),治疗组予以他汀类药物(阿托伐他汀钙分散片,20 mg/次,1次/d),对比两组心功能指标及血清BNP水平等。结果治疗组有效率(98.33%)高于对照组(85.00%),差异有统计学意义(χ^(2)=6.982,P=0.008);治疗前,两组左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)比较,差异无统计学意义(P>0.05);治疗后,治疗组LVEF高于对照组(P<0.05),LVEDD、LVEDV、LVESV均低于对照组(P<0.05),且治疗后低于治疗前(P<0.05);治疗前,两组N末端B型脑钠尿肽(NT-ProBNP)、超敏C反应蛋白(Hs-CRP)、血浆脑钠肽(BNP)比较,差异无统计学意义(P>0.05),治疗后,治疗组NT-ProBNP、Hs-CRP、BNP均低于对照组(P<0.05),且治疗后低于治疗前(P<0.05),差异有统计学意义(P<0.05);治疗组有效率(1.67%)低于对照组(16.67%),差异有统计学意义(χ^(2)=8.107,P=0.004)。结论β受体阻滞剂联合他汀类药物对慢性心衰的治疗效果显著,有效改善了BNP水平,提高了患者造血功能,可用于临床治疗慢性心衰,同时不良反应低。

β受体阻滞剂治疗婴幼儿血管瘤的最新现状

婴幼儿血管瘤是婴幼儿时期最常见的良性肿瘤,因其生长于头颈面部会造成面部畸形,影响患者身心健康,过去采用激素、手术等治疗,因遗留损害、并发症及复发率较高,使得临床治疗困难。自2008年以来,普萘洛尔作为一种非选择性β受体阻滞剂被报道可以用于治疗婴幼儿血管瘤后,虽其机制尚不明确,但其肯定的疗效和较小的不良反应受到人们广泛关注,后大量报道多种多类β受体阻滞剂治疗婴幼儿血管瘤均有明显效果,常见的β受体阻滞剂有普萘洛尔、阿替洛尔、纳多洛尔、噻吗洛尔等,用药方法包括口服、外用、联合等,这使得β受体阻滞剂治疗婴幼儿血管瘤的同时带来了一些困惑,如何选择药物及用法成为临床治疗的难题。本文拟对近年来β受体阻滞剂治疗婴幼儿血管瘤的疗效、方法、不良反应进行分析与总结,为临床治疗婴幼儿血管瘤用药提供参考。

不同种类降压药与骨质疏松症相关性研究进展

高血压和骨代谢在生理调节上有共同点,特定种类的降压药也可能影响骨密度或降低骨质疏松症相关骨折风险。虽然现有研究不足以明确哪类降压药对骨骼有益,但目前大部分研究支持血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和β受体拮抗剂能够改善骨密度或降低骨折风险,袢利尿剂则增加骨折风险,而噻嗪类利尿剂和钙通道阻滞剂相关结论互相矛盾。基于高血压的高患病率及降压药的广泛使用,探讨不同种类降压药对骨骼的影响很重要。通过总结近年来关于不同种类降压药与骨质疏松症相关性研究,为易患骨质疏松症高危人群的高血压患者选择合适的降压药提供临床依据。

普萘洛尔联合内镜下静脉曲张套扎术对肝硬化伴食管静脉曲张患者长期结局的影响探讨

目的比较内镜下静脉曲张套扎术(EVL)治疗与普萘洛尔联合EVL治疗对肝硬化伴食管静脉曲张患者长期结局的影响。方法回顾性分析166例肝硬化伴食管静脉曲张患者的临床资料,根据治疗方法的不同分为对照组(80例)和研究组(86例)。对照组实施单独EVL治疗,研究组采用普萘洛尔联合EVL治疗。比较两组的临床资料、并发症发生情况、5年生存率及死亡原因。结果两组患者的年龄、性别、肝硬化病因、静脉曲张度、血红蛋白、血小板计数、总胆红素、直接胆红素以及肝功能Child-Pugh分级比较,差异均无统计学意义(P>0.05)。随访终止,对照组患者发生静脉曲张出血17例(21.3%),肝肾综合征6例(7.5%),肝性脑病3例(3.8%),自发性腹膜炎4例(5.0%),肝腹水11例(13.8%);研究组患者发生静脉曲张出血22例(25.6%),肝肾综合征11例(12.8%),肝性脑病4例(4.7%),自发性腹膜炎6例(7.0%),肝腹水12例(14.0%)。两组患者静脉曲张出血、肝肾综合征、肝性脑病、自发性腹膜炎、肝腹水发生率比较,差异均无统计学意义(P>0.05)。Kaplan-Meier生存分析显示,研究组的5年生存率53.5%(46/86)低于对照组的70.0%(56/80),差异具有统计学意义(P<0.05)。研究组患者因肝功能衰竭死亡占比18.6%、死亡率46.5%高于对照组的6.3%、30.0%,差异有统计学意义(P<0.05)。两组因静脉曲张出血、肝癌、肺栓塞、心肌梗死、败血症、其他恶性肿瘤、脑出血死亡占比比较,差异无统计学意义(P>0.05)。结论普萘洛尔联合EVL治疗可能增加出血发生率和患者死亡率,单独EVL治疗比联合疗法更为安全,可继续作为肝硬化伴食管静脉曲张静脉出血的一级预防策略。

β-受体阻滞剂在慢性心力衰竭药物治疗中应用现状

目的通过对慢性心力衰竭药物治疗中β-受体阻滞剂的使用情况进行分析,了解其应用现状及其与指南要求剂量之间的符合情况。方法选择天津医科大学第二医院心脏科2004年慢性心力衰竭住院患者408例次及2005年4—7月门诊患者213例次,调查其一般临床资料及β-受体阻滞剂使用剂量。结果无禁忌证及不良反应住院患者中应用β-受体阻滞剂者为54.9%,其中仅4.0%达到指南所要求的靶剂量,24.9%达到50%靶剂量;使用美托洛尔者占86.1%,其最大使用剂量为(54.25±34.26)mg/d,为指南靶剂量(150mg/d)的36.17%。无禁忌证及不良反应门诊患者中应用β-受体阻滞剂者占77.5%,其中仅2.5%达到指南规定的靶剂量,26.6%达到50%靶剂量;使用美托洛尔者占89.7%,平均剂量为(52.50±28.42)mg/d,为指南靶剂量的35.0%。结论β-受体阻滞剂在慢性心力衰竭药物治疗中的使用与指南有较大差距。其使用以美托洛尔为主,各药物使用剂量普遍偏小。