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Beta-Blockers in Patients With COPD and CVD
Quick Takes
- Among patients with both chronic obstructive pulmonary (COPD) and cardiovascular disease, beta-blockers were associated with reduced all-cause mortality (hazard ratio, 0.70).
- Cardioselective beta-blockers were associated with reduced risk of COPD exacerbation (hazard ratio, 0.72), while noncardioselective beta-blockers had no significant impact in this regard.
Study Questions:
What is the effect of beta-blockers on respiratory function and survival in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD)?
Methods:
This systematic review and meta-analysis included observational studies and randomized controlled trials (RCTs) evaluating the effects of beta-blockers in patients with COPD and CVD. Outcomes of interest included COPD exacerbation, all-cause mortality, and in-hospital mortality.
Results:
A total of 49 studies (12 RCTs, 37 cohort or case-control studies), comprising 670,594 patients, were included. In a subset of 17 studies, beta-blockers were associated with lower risk of COPD exacerbation (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.67-0.89; p = 0.0003). This finding was driven by reduced risk associated with cardioselective beta-blockers (HR, 0.72; 95% CI, 0.56-0.94; p = 0.01), while noncardioselective beta-blockers had no significant impact on COPD exacerbation. In 22 studies examining all-cause mortality, beta-blockers were associated with reduced risk (HR, 0.70; 95% CI, 0.59-0.83; p < 0.0001). Cardioselective and noncardioselective beta-blockers were similar in this regard (HR, 0.60; 95% CI, 0.48-0.76; p < 0.0001, and HR, 0.74; 95% CI, 0.60-0.90; p = 0.003, respectively). Subgroup analyses in patients with heart failure and myocardial infarction demonstrated similarly favorable effects of beta-blockers on all-cause mortality. Beta-blockers were associated with reduced risk of in-hospital mortality in five studies (HR, 0.67; 95% CI, 0.46-0.99; p = 0.04). In five retrospective cohort studies, patients on beta-blockers were found to have lower average heart rates (mean difference, -7.87; p < 0.00001). Beta-blockers had no significant impact on pulmonary function tests (mean change in forced expiratory volume in 1 second, 0.06; 95% CI, -0.02 to 0.14).
Conclusions:
Beta-blocker use is associated with reduced in-hospital and all-cause mortality among patients with COPD and CVD. Use of cardioselective beta-blockers is associated with reduced risk of COPD exacerbation. Protective effects of beta-blockers may be driven in part by heart rate reduction.
Perspective:
This meta-analysis provides reassurance that patients with COPD who have a cardiovascular indication for beta-blockade should be treated according to current guidelines. By lowering heart rate, beta-blockers may provide protection against myocardial injury due to supply-demand mismatch, particularly when beta-agonist bronchodilators are used. Beta-blockers can also have favorable effects on lung inflammation and mucus secretion. The apparent differential effect of cardioselective and noncardioselective beta-blockers on COPD exacerbation is deserving of further study, but particularly in patients with COPD who have hyper-reactive airways, it may be prudent to choose cardioselective beta-blockers.
Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure
Keywords: Adrenergic beta-1 Receptor Antagonists, Adrenergic beta-Antagonists, Bronchodilator Agents, Cardiovascular Diseases, Geriatrics, Heart Failure, Hospital Mortality, Myocardial Infarction, Myocardial Ischemia, Pneumonia, Primary Prevention, Pulmonary Disease, Chronic Obstructive, Risk Assessment
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