β受体阻滞剂的应用资料.ppt

63 Expert consensus document on b-adrenergic receptor blockers The Task Force on Beta-Blockers of the European Society of Cardiology －European Heart Journal (2004) 25, 1341–1362. Classes of Recommendations Class I: Evidence and/or general agreement that a given procedure/treatment is beneficial,useful and effective Class II: Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the procedure/treatment Class IIa: Weight of evidence/opinion is in favour of usefulness/efficacy Class IIb: Usefulness/efficacy is less well established by evidence/opinion Class III: Evidence or general agreement that the treatment is not useful/effective and in some cases may be harmful Levels of Evidence Level of Evidence A：Data derived from multiple randomised clinical trials or metaanalyses Level of Evidence B：Data derived from a single randomised clinical trial or nonrandomised studies Level of Evidence C：Consensus of opinion of the experts and/or small studies Introduction β-Blocker therapy plays a major role in the treatment of cardiovascular diseases antiischaemic antiarryhthmic antihypertensive heart failure Pharmacokinetic properties There are important pharmacokinetic differences among β-blockers Effects mediated by β1- and β2-adrenoceptors Classification of β-blockers β-Blockers can be broadly classified into non-selective β1-selective some exert a weak agonist response can stimulate and block the β-adrenoceptor Classification of β-blockers Several β-blockers have peripheral vasodilator activity mediated via α1-adrenoceptor blockade β2-adrenergic receptor agonism mechanisms independent of the adrenoceptor blockade In addition, β-blockers can be classified as lipophilic or hydrophilic Lipophilic drugs Lipophilic drugs (metoprolol, propranolol, timolol) are rapidly and completely absorbed from the gastrointestinal tract accumulate in patients with reduced hepatic blood flow (i.e., elderly, congestive heart failure, liver cirrho