What medications are beta blockers? Beta blockers: list of non-selective and cardioselective drugs, mechanism of action and contraindications

For more than 20 years, beta-blockers have been considered one of the main drugs in the treatment of heart diseases. Scientific studies have obtained convincing data that served as the basis for including this group of drugs in modern recommendations and protocols for the treatment of cardiac pathologies.

Blockers are classified depending on their mechanism of action, which is based on the influence of a certain type of receptor. Today there are three groups:

alpha-blockers;
beta blockers;
alpha-beta adrenergic blockers.

Alpha blockers

Drugs whose action is aimed at blocking alpha-adrenergic receptors are called alpha-blockers. The main clinical effects are dilation of blood vessels and, as a result, a decrease in total peripheral vascular resistance. This is followed by relief of blood flow and reduction of pressure.

In addition, they are able to lower cholesterol levels in the blood and influence fat metabolism in the body.

Beta blockers

There are different subtypes of beta-adrenergic receptors. Depending on this, beta blockers are divided into groups:

Selective, which, in turn, are divided into 2 types: those with internal sympathomimetic activity and those without;
Non-selective - block both beta-1 and beta-2 receptors;

Alpha-beta blockers

Representatives of this group of drugs reduce systole and diastole and heart rate. One of their main advantages is the lack of influence on the blood circulation of the kidneys and peripheral vascular resistance.

Mechanism of action of adrenergic blockers

Due to this, blood from the left ventricle, when the myocardium contracts, immediately enters the largest vessel of the body - the aorta. This point is important when the functioning of the heart is impaired. When taking these medications with combined action, there is no negative effect on the myocardium and, as a result, mortality is reduced.

General characteristics of ß-blockers

Beta-adrenergic receptor blockers are a large group of drugs that have the properties of competitively (reversibly) and selectively inhibiting the binding of catecholamines to the receptors of the same name. This group of drugs began to exist in 1963.

Then the drug Propranolol was synthesized, which is still in wide clinical use today. Its creators were awarded the Nobel Prize. Since that time, a number of drugs with adrenergic blocking properties have been synthesized, which had a similar chemical structure, but differed in some characteristics.

Properties of beta blockers

In a very short time, beta-blockers have taken a leading place in the treatment of most cardiovascular diseases. But if we go back into history, not so long ago the attitude towards these medications was slightly skeptical. First of all, this is due to the misconception that medications can reduce the contractility of the heart, and beta blockers were rarely used for diseases of the cardiac system.

However, today their negative effect on the myocardium has been refuted and it has been proven that with constant use of adrenergic blockers, the clinical picture changes dramatically: the stroke volume of the heart and its tolerance to physical activity increases.

The mechanism of action of beta-blockers is quite simple: the active substance, penetrating into the blood, first recognizes and then captures the molecules of adrenaline and norepinephrine. These are hormones synthesized in the adrenal medulla. What happens next? Molecular signals from the captured hormones are transmitted to the corresponding cells of the organs.

There are 2 main types of beta-adrenergic receptors:

Both receptors are present in the organocomplex of the central nervous system. There is also another classification of adrenergic blockers depending on their ability to dissolve in water or fat:

Indications and restrictions

The area of medical science in which beta blockers are used is quite wide. They are used in the treatment of many cardiovascular and other diseases.

The most common indications for the use of these drugs:

Disputes about when drugs of this group can be used and when not continue to this day. The list of diseases for which the use of these substances is not advisable is changing, as scientific research is constantly underway and new medications from the group of beta blockers are being synthesized.

Therefore, a conventional line has been defined between absolute (when it should never be used) and relative (when there is little risk) indications for the use of beta blockers. If in some sources certain contraindications are considered absolute, then in others they are relative.

According to clinical protocols for the treatment of cardiac patients, it is strictly forbidden to use blockers when:

severe bradycardia;
high degree atrioventricular block;
cardiogenic shock;
severe lesions of peripheral arteries;
individual hypersensitivity.

Such drugs are relatively contraindicated for insulin-dependent diabetes mellitus and depression. If these pathologies are present, you need to weigh all the expected positive and negative effects before use.

List of drugs

Today the list of drugs is very large. Each drug listed below has a convincing evidence base and is actively used in clinical practice.

Non-selective drugs include:

Labetalol.
Dilevalol.
Bopindolol.
Propranolol.
Obzidan.

Based on the above, we can draw conclusions about the success of using beta-blockers to control heart function. This group of drugs is not inferior in its properties and effects to other cardiological drugs. When a patient has a high risk of cardiovascular disorders in the presence of other concomitant pathologies, then in this case the role of beta-blockers is very significant.

When choosing a drug for treatment, preference should be given to more modern representatives of this class (presented in the article), since they allow for a stable reduction in blood pressure and correction of the underlying disease without worsening a person’s well-being.

Treatment of cardiac diseases in modern medical practice is almost impossible to imagine without the use of a special group of drugs - beta blockers.

The list of diseases for which therapy using these drugs is used is extensive. They effectively normalize blood pressure levels and heart rate.

However, like any medications, beta blockers require caution and care during therapy.

Beta blocker drugs are used in the treatment of the following diseases:

a chronic condition of high blood pressure in the body;
increased blood pressure due to other pathologies;
increased rhythm of contractions of the heart muscle;
painful sensations in the heart with diagnosed coronary artery disease;
rehabilitation period after a previous heart attack;
pathological changes in heart rate;
functional disorders in the myocardium;
thickening of the ventricular wall;
abnormal increase in the size of the ventricle and septum;
a condition in which the mitral valve protrudes into the cavity of one atrium at the time of contraction of the other;
asynchronous contraction of ventricular myocardial cells or risk of sudden death;
high blood pressure due to surgery;
migraines;
alcohol and drug addiction.

Classification

Drugs in this group have several classifications, which divide drugs according to various criteria.

All beta blockers are divided depending on the characteristics of their effect on receptors:

non-selective drugs;
selective drugs.

A group of non-selective drugs do not have the ability to select adrenergic receptors for blocking. They affect all structures.

This effect on the body manifests itself in the form of a decrease in blood clotting and a decrease in the number of plaques, the level of pressure in the blood vessels also decreases, the rhythm of myocardial contractions is normalized, and cell membranes are stabilized.

The most popular drugs among non-selective beta blockers are:

Sandinorm;
Vistagen;
Korgard;
Vistagan;
Trazikor;
Visken;
Sotalex;
Okumol;
Obzidan.

The cost of these drugs is very diverse and varies from 50 rubles. up to 1000 rub. per package.

Selective beta blockers work specifically at a specific type of receptor. The second name of this group is cardioselective. Blocked receptors are located in the cells of the myocardium, lipoid tissue, and also in the intestines.

Representatives of the selective group are:

Metoprolol;
Tenormin;
Esmolol;
Coriol;
Nebikor;
Cordanum;
Vazacor;
Acekor.

The cost of drugs in pharmacies varies. It depends on the manufacturer, the concentration of the active ingredient, and the number of tablets in the package.

Domestic drugs are much cheaper than foreign analogues. Their cost, as a rule, does not exceed 250 rubles. Foreign funds have a price above 500 rubles.

In addition to selectivity, the classification can be based on the progressiveness and novelty of the drug. Thus, among the drugs in the group of beta blockers, 3 generations are distinguished.

The 1st generation of drugs is characterized by non-selective action. These include:

Propranolol;
Sotalol;
Timolol.

The 2nd generation of drugs from the beta blocker group includes selective drugs:

Metoprolol;
Esmolol.

The 3rd generation of drugs combines selective and non-selective effects:

Talinolol;
Celiprolol;
Carteolol.

Currently, it is 3rd generation drugs that are most often used. They are distinguished by the smallest number of contraindications and.

However, you cannot choose your own medicine. This can only be done by the attending physician based on the results of a general examination of the body.

The highest quality and most effective Beta blocker

The leading position in terms of effectiveness is occupied by a group of 3rd generation beta blockers. This is the most modern and progressive type of drugs that act on adrenergic receptors.

The best among them are considered to be drugs under the trade name, as well as.

Carvedilol is a selective drug. During the period of its use, there is an effective decrease in the level of pressure in the blood vessels due to the expansion of the lumen, and the number of plaques also decreases.

– combines 2 types of action. It effectively reduces blood pressure and also helps in the fight against heart disease. Nebivolol is a more expensive drug than Carvediol.

How do beta blockers affect blood pressure?

Beta blockers block the work of special adrenergic receptors in the body, which are located in the cells of cardiac muscle tissue, liver, fatty tissue, etc. As a result of a decrease in receptor activity, the following changes occur in the body:

the heart rate slows down somewhat and myocardial cells require less oxygen;
the process of blood flow in the coronary region is normalized and high-quality nutrition of the heart muscle occurs;
the substance renin is produced, which reduces peripheral resistance;
special active biological substances are produced that expand the vascular lumen;
cell membranes become less permeable to sodium and potassium ions.

All of these processes occur almost simultaneously, due to this, a decrease in blood pressure occurs. Additionally, the effect of normalizing heart rate and myocardial function is noted.

Instructions for use

The duration of the course of treatment, dosage of drugs and the general treatment regimen are determined. In order for therapy to be effective, the general condition of the patient’s body must be taken into account, and whether there are any contraindications is noted.

In addition, regular monitoring of the patient’s condition is carried out. If side effects are detected, the doctor will replace the medications with similar ones.

Throughout treatment, blood pressure and heart rate readings should be monitored. Even with minor deviations from the norm, you should immediately consult a doctor to adjust the treatment.

Side effects

In some cases, beta blocker therapy is accompanied by negative side effects:

feeling of chronic fatigue and increased fatigue;
disturbance of the rhythm of heart contractions in the direction of slowing down;
increased asthmatic symptoms;
intoxication of the body, which is manifested by nausea and accompanying vomiting;
decrease in blood glucose concentration;
excessive drop in blood pressure levels;
pathological changes in metabolic processes;
increased symptoms of lung diseases;
impaired concentration;
dyspeptic disorders of the digestive system;
decreased sexual desire;
development of inflammatory processes on the mucous membrane of the eyes;
allergic rashes over the entire area of the skin;
circulatory disorders in the extremities.

If side effects occur during therapy with these medications, stop taking the drug. The doctor selects more suitable analogues.

Contraindications

asthma;
individual intolerance to the components of a particular drug;
heart rhythm pathology in the form of a decrease in the number of contractions;
violation of impulse conduction from the atrium to the ventricle;
insufficient functioning of the left ventricle;
vascular diseases;
low blood pressure.

In addition, beta blockers should not be taken during pregnancy or during pregnancy planning.

Overdose

If beta blockers are taken incorrectly, or the recommended dosage and duration of treatment are exceeded, an overdose may occur. It is accompanied by the following symptomatic manifestations:

severe dizziness;
heart rhythm disturbances;
a sharp decrease in heart rate;
blue discoloration of the skin;
convulsions;
coma.

If drug poisoning occurs due to an overdose, it is necessary to provide first aid to the victim as soon as possible. It includes:

washing the patient's stomach;
taking absorbent drugs;
emergency medical call.

Depending on the symptoms, the patient may be prescribed different drugs to normalize the condition. In case of heart rhythm disturbances, the victim is given atropine, adrenaline or dopamine, depending on the characteristics of the pathology.

Difference from Alpha blockers

All drugs that inhibit and block the activity of adrenergic receptors are divided into the following groups:

beta blockers.

Alpha group drugs act on the corresponding receptors. Their influence is aimed at simplifying the process of blood flow, which in turn reduces the level of pressure in the vessels. An additional effect when taking alpha blockers can be considered a decrease in cholesterol levels.

Arterial hypertension requires mandatory treatment with medications. New drugs are constantly being developed to bring blood pressure back to normal and prevent dangerous consequences such as stroke and heart attack. Let's take a closer look at what alpha and beta blockers are - a list of drugs, indications and contraindications for use.

Adrenolytics are drugs that have one pharmacological effect - the ability to neutralize adrenaline receptors of the heart and blood vessels. They turn off the receptors that normally respond to norepinephrine and adrenaline. The effects of adrenolytics are opposite to those of norepinephrine and adrenaline and are characterized by a decrease in pressure, dilation of blood vessels and narrowing of the lumen of the bronchi, and a decrease in glucose in the blood. The drugs act on receptors located in the heart and walls of blood vessels.

Alpha-blocker drugs have a dilating effect on the blood vessels of organs, especially the skin, mucous membranes, kidneys and intestines. Due to this, an antihypertensive effect occurs, a decrease in peripheral vascular resistance, an improvement in blood flow and blood supply to peripheral tissues.

Let's look at what beta blockers are. This is a group of drugs that bind to beta-adrenergic receptors and block the effect of catecholamines (norepinephrine and adrenaline) on them. They are considered the main drugs in the treatment of essential arterial hypertension and high blood pressure. They have been used for this purpose since the 60s of the 20th century.

The mechanism of action is expressed in the ability to block beta adrenergic receptors of the heart and other tissues. The following effects arise:

Beta blockers have not only a hypotensive effect, but also a number of other properties:

Antiarrhythmic activity due to inhibition of the effects of catecholamines, a decrease in the speed of impulses in the area of the atrioventricular septum and a slowdown in sinus rhythm;
Antianginal activity. Beta-1 adrenergic receptors of blood vessels and myocardium are blocked. Because of this, heart rate, myocardial contractility, and blood pressure decrease, the duration of diastole increases, and coronary blood flow improves. In general, the heart's need for oxygen decreases, tolerance to physical stress increases, periods of ischemia decrease, and the frequency of anginal attacks decreases in patients with post-infarction angina and exertional angina;
Antiplatelet ability. Platelet aggregation slows down, prostacyclin synthesis is stimulated, blood viscosity decreases;
Antioxidant activity. There is an inhibition of free fatty acids that are caused by catecholamines. The need for oxygen for further metabolism is reduced;
Venous blood flow to the heart and the volume of circulating plasma decrease;
Insulin secretion decreases due to inhibition of glycogenolysis;
There is a sedative effect, the contractility of the uterus increases during pregnancy.

Indications for use

Alpha-1 blockers are prescribed for the following pathologies:

Alpha 1,2 blockers are used for the following conditions:

pathology of cerebral circulation;
migraine;
dementia, which is caused by a vascular component;
pathology of peripheral circulation;
problems with urination due to a neurogenic bladder;
diabetic angiopathy;
dystrophic diseases of the cornea;
vertigo and pathologies of the functioning of the vestibular apparatus associated with the vascular factor;
optic neuropathy associated with ischemia;
prostatic hypertrophy.

Important: Alpha-2 blockers are prescribed only for the treatment of impotence in males.

Non-selective beta-1,2 blockers are used in the treatment of the following pathologies:

arterial;
increased intraocular pressure;
migraine (preventive purposes);
hypertrophic cardiomyopathy;
heart attack;
sinus tachycardia;
tremor;
bigeminy, supraventricular and ventricular arrhythmia, trigeminy (preventive purposes);
angina pectoris;
mitral valve prolapse.

Selective beta-1 blockers are also called cardioselective because of their effect on the heart and less on blood pressure and blood vessels. They are prescribed in the following conditions:

Alpha-beta blockers are prescribed in the following cases:

arrhythmia;
stable angina;
CHF (combined treatment);
high blood pressure;
glaucoma (eye drops);
hypertensive crisis.

Classification of drugs

There are four types of adrenergic receptors in the walls of blood vessels (alpha 1 and 2, beta 1 and 2). Drugs from the group of adrenergic blockers can block different types of receptors (for example, only beta-1 adrenergic receptors). Drugs are divided into groups depending on the shutdown of certain types of these receptors:

Alpha blockers:

alpha-1 blockers (silodosin, terazosin, prazosin, alfuzosin, urapidil, tamsulosin, doxazosin);
alpha-2 blockers (yohimbine);
alpha-1, 2-blockers (dihydroergotamine, dihydroergotoxin, phentolamine, nicergoline, dihydroergocristine, proroxan, alpha-dihydroergocriptine).

Beta blockers are divided into the following groups:

non-selective adrenergic blockers (timolol, metypranolol, sotalol, pindolol, nadolol, bopindolol, oxprenolol, propranolol);
selective (cardioselective) adrenergic blockers (acebutolol, esmolol, nebivolol, bisoprolol, betaxolol, atenolol, talinolol, esatenolol, celiprolol, metoprolol).

List of alpha-beta adrenergic blockers (they include alpha and beta adrenergic receptors at the same time):

labetalol;
proxodolol;
carvedilol.

Please note: The classification shows the names of the active substances that are part of the drugs in a certain group of blockers.

Beta blockers also come with or without intrinsic sympathomimetic activity. This classification is considered auxiliary, since it is used by specialists to select the necessary medicine.

List of drugs

Common names for alpha-1 blockers:

Alfuzosin;
Dalfaz;
Artesin;
Zoxon;
Urocard;
Prazosin;
Urorek;
Miktosin;
Tamsulosin;
Cornam;
Ebrantil.

Alpha-2 blockers:

Yohimbine;
Yohimbine hydrochloride.

Alpha-1,2-blockers:

Redergin;
Ditamine;
Nicergoline;
Pyrroxane;
Phentolamine.

Atenol;
Atenova;
Atenolan;
Betacard;
Tenormin;
Sectral;
Betoftan;
Xonephus;
Optibetol;
Bisogamma;
Bisoprolol;
Concor;
Tirez;
Betalok;
Serdol;
Binelol;
Cordanum;
Breviblock.

Non-selective beta blockers:

Sandorm;
Trimepranol;
Visken;
Inderal;
Obzidan;
Darob;
Sotalol;
Glaumol;
Thymol;
Timoptic.

Alpha-beta blockers:

Proxodolol;
Albetor;
Bagodilol;
Carvenal;
Credex;
Labetol;
Abetol.

Side effects

Common side effects from taking adrenergic blockers:

Side effects from taking alpha-1 blockers:

swelling;
severe decrease in pressure;
arrhythmia and tachycardia;
dyspnea;
runny nose;
dry mouth;
pain in the chest area;
decreased libido;
pain during erection;
urinary incontinence.

Side effects when using alpha-2 receptor blockers:

increase in pressure;
anxiety, excessive excitability, irritability and physical activity;
tremor;
decreased frequency of urination and volume of fluid.

Side effects from alpha-1 and -2 blockers:

decreased appetite;
sleep problems;
excessive sweating;
coldness of hands and feet;
increased acidity in the stomach.

Common side effects of beta blockers:

Non-selective beta blockers may cause the following conditions:

vision pathologies (fogginess, feeling that a foreign body has entered the eye, tearfulness, double vision, burning);
cardiac ischemia;
colitis;
cough with possible attacks of suffocation;
a sharp decrease in pressure;
impotence;
fainting;
runny nose;
an increase in blood uric acid, potassium and triglycerides.

Alpha-beta blockers have the following side effects:

decrease in blood platelets and leukocytes;
formation of blood in the urine;
increased cholesterol, sugar and bilirubin;
pathologies of the conduction of heart impulses, sometimes leading to blockade;
worsened peripheral circulation.

Interaction with other drugs

The following drugs have favorable compatibility with alpha blockers:

Favorable combination of beta blockers with other drugs:

The combination with nitrates is successful, especially if the patient suffers not only from hypertension, but also from coronary heart disease. The hypotensive effect is enhanced, bradycardia is leveled by tachycardia, which is caused by nitrates.
Combination with diuretics. The effects of diuretics are increased and prolonged due to the inhibition of the release of renin from the kidney by beta blockers.
ACE inhibitors and angiotensin receptor blockers. If there are drug-resistant arrhythmias, you can carefully combine use with quinidine and procainamide.
Calcium channel blockers of the dihydropyridine group (cordafen, nikirdipine, phenigidine). You can combine it with caution and in small dosages.

Dangerous combinations:

Calcium channel blockers that belong to the verapamil group (isoptin, gallopamil, finoptin). The frequency and strength of heart contractions decreases, atrioventricular conduction becomes worse, hypotension, bradycardia, acute left ventricular failure and atrioventricular block increase.
Sympatholytics - octadine, reserpine and drugs containing it (rauvazan, brinerdine, adelfan, raunatin, cristepine, trirezide). There is a sharp weakening of sympathetic influences on the myocardium, and associated complications may arise.
Cardiac glycosides, direct M-cholinomimetics, anticholinesterase drugs and tricyclic antidepressants. The likelihood of blockade, bradyarrhythmia and cardiac arrest increases.
Antidepressants-MAO inhibitors. There is a possibility of hypertensive crisis.
Typical and atypical beta-agonists and antihistamines. These drugs are weakened when used together with beta blockers.
Insulin and sugar-lowering medications. The hypoglycemic effect is enhanced.
Salicylates and butadione. There is a weakening of the anti-inflammatory effect;
Indirect anticoagulants. The antithrombotic effect is weakened.

Contraindications to taking alpha-1 blockers:

Contraindications to taking alpha-1,2 blockers:

arterial hypotension;
acute bleeding;
lactation;
pregnancy;
myocardial infarction that occurred less than three months ago;
organic heart lesions;
atherosclerosis of peripheral vessels in severe form.

Contraindications for alpha-2 blockers:

excessive sensitivity to the components of the drug;
severe pathologies of kidney or liver functioning;
blood pressure surges;
uncontrolled hypertension or hypotension.

General contraindications to taking non-selective and selective beta-blockers:

excessive sensitivity to the components of the drug;
cardiogenic shock;
sinoatrial block;
weakness of the sinus node;
hypotension (blood pressure less than 100 mm);
acute heart failure;
atrioventricular block of the second or third degree;
bradycardia (pulse less than 55 beats/min.);
CHF in the stage of decompensation;

Contraindications to taking non-selective beta blockers:

bronchial asthma;
obliterating vascular diseases;
Prinzmetal's angina.

Selective beta blockers:

lactation;
pregnancy;
pathology of peripheral circulation.

Hypertensive patients should use the medications discussed strictly according to the instructions and in the dose prescribed by the doctor. Self-medication can be dangerous. At the first appearance of side effects, you should immediately contact a medical facility.

Still have questions? Ask them in the comments! A cardiologist will answer them.

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When taking β-blockers, side effects often occur: cardiovascular, metabolic, respiratory, central system, sexual dysfunction, withdrawal syndrome.

Cardiovascular complications.β-Adrenergic blockers reduce heart rate, the activity of ectopic pacemakers and slow conduction, and also lengthen the refractory period of the AV node. Due to this, they can cause severe bradycardia and AV block. These effects usually develop in patients with impaired sinoatrial node function and AV conduction and rarely occur with intravenous administration of β-blockers in patients with acute MI and when taken orally in connection with CHF.

The drugs reduce tissue blood flow due to blockade of vascular β2-adrenergic receptors and unbalanced stimulation of vascular α-adrenergic receptors. As a result, they can provoke coldness of the extremities and the development of Raynaud's syndrome, as well as aggravate symptoms in severe peripheral atherosclerosis. However, in patients with peripheral and coronary atherosclerosis, the positive effects of β-blockers are of important clinical importance. The listed side effects are less pronounced for drugs with a vasodilating effect and β1-selective β-blockers. Drugs in this group may increase coronary artery tone in part due to unbalanced α-adrenergic vasoconstriction.

Metabolic complications. In patients with type 1 diabetes mellitus, non-selective beta-blockers may mask some warning symptoms of hypoglycemia (tremor, tachycardia); other signs of hypoglycemia, such as sweating, persist. For this reason, selective β-blockers should be preferred in such patients. In any case, the clinical benefit of treatment with β-blockers outweighs the possible risk, at least after MI. One study showed a reduction in the incidence of new cases of diabetes mellitus when patients with CHF were treated with carvedilol.
Pulmonary complications.β-blockers can lead to life-threatening bronchial obstruction and are contraindicated in patients with bronchial asthma or COPD with a severe bronchial obstruction component. In some patients with COPD, the potential benefit of beta-blockers may outweigh the risk of worsening bronchial conduction. However, a history of bronchial asthma should be considered a contraindication for the use of any beta-blockers, while in COPD beta-blockers are not contraindicated, except for severe bronchial conduction disturbances.
Side effects from the central nervous system. These include weakness, headache, sleep disturbances, insomnia, excessively vivid dreams and depression. They occur less frequently when hydrophilic β-blockers are prescribed. In some patients, weakness may be due to decreased blood flow to skeletal muscles, while in others it develops due to the central action of the drug.
Sexual dysfunction. In some patients, beta-blockers may cause or worsen impotence and decreased libido.
Withdrawal syndrome. After abrupt withdrawal of β-blockers with long-term use, withdrawal syndrome may develop, including increased blood pressure, arrhythmias, and worsening angina. This syndrome is associated with increased sensitivity of β-adrenergic receptors with prolonged treatment.

There are certain contradictions in the data about what side effects are typical for beta-blockers and how often they occur due to the insufficient methodological level of studies in which these drugs were used.

A recent meta-analysis provides insight into the true incidence of sexual dysfunction, fatigue, and depression. It included 15 large studies that met strict methodological requirements and involved a total of more than 35,000 patients. It turned out that the use of beta-blockers did not significantly affect the annual risk of depressive symptoms. β-blockers caused a slight but statistically significant increase in the risk of fatigue (18 cases per 1000 patients treated per year). In addition, they caused a small but statistically significant increase in the incidence of erectile dysfunction (5 cases per 1000 patients treated per year). The use of selective β-blockers is significantly less likely to cause side effects compared to non-selective ones.

Martsevich S.Yu., Tolpygina S.N.

Beta blockers