PMID: 2478808Jan 1, 1989Paper

Is activation of the sympathetic nervous system beneficial or detrimental to the patient with chronic heart failure? Lessons learned from clinical trials with beta-adrenergic agonists and antagonists.

Journal of Cardiovascular Pharmacology
M Packer

Abstract

The sympathetic nervous system is markedly activated in most patients with congestive heart failure, but it is not clear whether such activity is clinically beneficial (and should be enhanced) or detrimental (and should be blocked). Some insights into this question can be gained by reviewing the results of clinical trials with beta-adrenergic agonists and antagonists. Long-term treatment with agents that stimulate the beta-receptor (prenalterol and pirbuterol) has not proved to be useful in the treatment of chronic heart failure; moreover, prolonged treatment with beta-agonists (dobutamine and pirbuterol) may adversely affect survival. Most of the studies with beta-agonists, however, have employed agents that interact nonselectively and with a high degree of intrinsic activity with both beta 1-and beta 2-receptors. It is possible that the problems that have been encountered with the use of beta-agonists could be minimized by agents that are more selective and have less intrinsic activity. Yet, such agents may actually function as beta-adrenergic antagonists (rather than agonists) in states of heightened sympathetic activity. Indeed, sustained therapy with drugs that attenuate the effects of the sympathetic nervous system (by bl...Continue Reading

Citations

Jan 29, 2000·The Journal of Thoracic and Cardiovascular Surgery·C A WalkerF G Spinale
Mar 25, 1993·The American Journal of Cardiology·E J Eichhorn
May 1, 1992·The American Journal of Medicine·E J Eichhorn
May 21, 2011·Journal of the American College of Cardiology·Nathaniel M HawkinsJohn J V McMurray

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