循環器ジャーナル65巻1号

2017年01月発行

特集 Clinical Scenarioによる急性心不全治療 Ⅷ．トピックス

β遮断薬は本当に切ってはいけないのか？

著者： 安村良男¹

所属機関： ¹大阪警察病院循環器内科

ページ範囲：P.167 - P.169

Point
・β遮断薬導入後の遠隔期に発症した急性心不全の場合には基本的にはβ遮断薬を中断しない．
・心原性ショックや重症の急性心不全の場合はβ遮断薬の短期間の休薬を考慮する．
・休薬した場合も急性心不全が安定すれば，可能な限り再導入を試みる．

参考文献

1) Cattis WA, O'Connor CM, Leimberger JD, et al:Clinical outcomes in patients on beta-blocker therapy admitted with worsening chronic heart failure. Am J Cardiol 91:169-174, 2003

2) Butler J, Young JB, Abraham WT, et al:Beta-blocker use and outcomes among hospitalized heart failure patients. J Am Coll Cardiol 47:2462-2469, 2006

3) Fonarow GC, Abraham WT, Albert NM, et al:Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure. J Am Coll Cardiol 52:190-199, 2008

4) Orso F, Baldasseroni S, Fabbri G, et al:Role of beta-blockers in patients admitted for worsening heart failure in a real world setting:data from the Italian survey on acute heart failure. Eur J Heart Fail 11:77-84, 2009

5) Poole-Wilson PA, Swedberg K, Cleland JG, et al:Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial（COMET):randomized controlled trial. Lancet 362:7-13, 2003

6) Metra M, Cleland JGF, Di Lenarda A, et al:Should beta-blocker therapy be reduced or withdrawn after an episode of decompensated heart failure? Results from COMET. Eur J Heart Fail 9:901-909, 2007

7) Jondeau G, Neuder Y, Eicher J-C, et al:B-CONVINCED:Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J 30:2186-2192, 2009

8) Eichhorn EJ, Bristow MR:Practical guidelines for initiation of beta-adrenergic blockade in patients with chronic heart failure. Am J Cardiol 79:794-798, 1997

9) Dickstein K, Cohen-Solal A, Filippatos G, et al:ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC（HFA）and endorsed by the European Society of Intensive Care Medicine（ESICM). Eur Heart J 29:2388-2442, 2008

10) Gheorghiade M, De Luca L, Fonarow GC, et al:Pathophysiologic targets in the early phase of acute heart failure syndromes. Am J Cardiol 96:11G-17G, 2005

11) Grosu A, Senni M, Lacovoni A, et al:CArdiac Resynchronization In combination with BEta blocker treatment in advanced chronic Heart Failure（CARIBE-HF):the results of the CARIBE-HF study. Acta Cardiol 66:573-580, 2011