Rational use of beta blockers - Linda Bryant

Dr Linda Bryant talks about the rational use of beta blockers in primary care. Linda is a Clinical Advisory Pharmacist working part time in a general practice and teaching postgraduate clinical pharmacy. Linda’s PhD investigated clinical medication reviews in primary care and she has advocated strongly for the role of independent clinical pharmacists in PHOs and general practice.

Topics

the place for beta blockers in hypertension
what to use instead of beta blockers
when to use a beta blocker
when it makes sense to use spironolactone
differences in beta blockers with regard to selectivity
use of beta blockers with post-acute myocardial infarction
considerations when stopping beta blockers
role of beta blockers in angina
assessing that patient is fully beta blocked
role of beta blockers in heart failure, including which to choose
role of beta blockers in atrial fibrillation

Take home messages

For hypertension use beta blockers as 4th line - first choice treatments for hypertension with no additional complications; ACE inhibitors, channel blockers and thiazides.
For post- MI without heart failure, angina or AF - titrate down slowly after 12 months of therapy.
For heart failure - use beta blocker, titrate dose slowly up as far as you can (for people with reduced ejection fraction).
For atrial fibrillation - use a beta blocker.
Useful beta blocker: bisoprolol.