Variations in pharmacology of β-blockers may contribute to heterogeneous results in trials of perioperative β-blockade

Robert G. Badgett, Valerie A. Lawrence, Steven L. Cohn

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

Background: Randomized controlled trials and meta-analyses provide conflicting guidance on the role of β-adrenergic receptor blockers (β-blockers) in reducing perioperative complications. We hypothesize that variability in trial results may be due in part to heterogeneous properties ofβ-blockers. First, we propose that the extent of β-blocker metabolism by cytochrome P-450 and the time available to titrate the dosage before surgery (titration time) may interact; dependence on P-450 may be most harmful when titration time is short. Second, β-blockers vary in their selectivity for the β-1 receptor and reduced selectivity may contribute to cerebral ischemia. Methods: We used meta-analysis and meta-regression of existing trials to explore the role of these pharmacological properties. Results: We found that both of these pharmacological factors are significantly associated with reduced efficacy of β-blockers. Conclusions: Pharmacological properties of β-blockers may contribute to heterogeneous trial results. Many trials have used metoprolol, which is extensively metabolized by cytochrome P450 and is less selective for the β-1 receptor. For these two reasons, the efficacy of metoprolol to prevent perioperative cardiac complications should be compared with the efficacy of other β-blockers.

Original languageEnglish (US)
Pages (from-to)585-592
Number of pages8
JournalAnesthesiology
Volume113
Issue number3
DOIs
StatePublished - Sep 2010

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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