Table 2.
Summary of studies on the symptom and outcome effects of β-blockers in specific CVDs with coexisting COPD [18, 24, 33–50]
| CVD | Publication | Population | Intervention/comparator | Key results | Conclusions |
|---|---|---|---|---|---|
| Hypertension | Au et al. [45] | Hypertension and COPD | β-blocker versus CCB | β-blockers decreased all-cause mortality (HR 0.57) | β-blockers are beneficial in COPD, preexisting cardiac disease, and hypertension |
| Cazzola et al. [46] | Hypertension and mild-to-moderate COPD | Nebivolol versus nifedipine | BP reduced with both treatments; FEV1 reduced with nebivolol but not nifedipine; nebivolol safe over 2 weeks | Nebivolol in patients with hypertension and mild-to-moderate COPD safe over 2 weeks | |
| HF | Jabbour et al. [24] | Chronic HF and COPD | Metoprolol versus carvedilol versus bisoprolol | FEV1 highest with bisoprolol, followed by metoprolol and carvedilol, respectively | Switching between cardioselective and nonselective β-blockers resulted in changes in airway function in COPD |
| Kubota et al. [35] | HFrEF and COPD | Cardioselective versus nonselective β-blocker versus nonuse | Heart rate lower in β-blocker groups versus nonuse; 2-year all-cause/cardiovascular mortality lower with nonselective β-blockers versus nonuse, but not with cardioselective β-blockers versus nonuse | Nonselective β-blockers reduced all-cause/cardiovascular mortality in HFrEF and COPD | |
| Sessa et al. [36] | HF and COPD and diabetes mellitus | Metoprolol versus carvedilol | HF hospitalization risk 38% lower with metoprolol than carvedilol at 1 year; no difference in survival or COPD hospitalization | HF hospitalization risk increased with carvedilol, but no difference in survival or COPD hospitalization risk | |
| Hawkins et al. [37] | HF and moderate/severe COPD | Bisoprolol versus placebo | FEV1 reduced after 4 months of bisoprolol compared with placebo, but reversibility following inhaled β2-agonists not impaired by bisoprolol; exacerbations similar; symptoms/quality of life not impaired by bisoprolol | Bisoprolol in HF and moderate/severe COPD reduced FEV1; symptoms and quality of life not impaired | |
| Lainscak et al. [38] | Chronic HF and COPD | Bisoprolol versus carvedilol | Bisoprolol increased FEV1 compared with baseline and reduced heart rate and had fewer adverse events than carvedilol; adverse events in 19% of patients with bisoprolol versus 42% with carvedilol | β-blockers caused adverse events in chronic HF and COPD; bisoprolol improved pulmonary function and had fewer adverse events than carvedilol | |
| Liao et al. [39] | Chronic HF and COPD | Metoprolol versus bisoprolol versus carvedilol versus nonuse | Only bisoprolol reduced mortality and decreased hospitalization due to chronic HF exacerbation; no association between β-blocker use and COPD exacerbation | In chronic HF and COPD, bisoprolol reduced mortality and hospitalization compared with carvedilol and metoprolol | |
| Andersson et al. [40] | Right-sided HF and COPD | β-blocker (selectivity not specified) versus nonuse | HR for mortality with β-blockers 0.90 versus nonuse | β-blockers reduced mortality in right-sided HF and COPD | |
| Higuchi et al. [41] | Acute HF (LVEF < 50%) with/without COPD | β-blocker (selectivity not specified) in patients with versus without COPD | β-blockers associated with lower all-cause mortality with (HR 0.39) and without (HR 0.62) COPD due to lower noncardiac mortality, which persisted in those with COPD after multivariate adjustment (HR 0.40) owing to lower noncardiac (but not cardiac) mortality | β-blockers associated with lower all-cause mortality in HF + COPD owing to lower noncardiac mortality | |
| Mentz et al. [47] | HF and COPD | Cardioselective or nonselective β-blocker in patients with versus without COPD | Cardioselective and nonselective β-blockers associated with lower risk-adjusted mortality with and without COPD; β-blocker selectivity not associated with different outcomes with versus without COPD | β-blocker selectivity not associated with differences in outcomes with versus without COPD | |
| Su et al. [48] | HF and COPD | Metoprolol versus bisoprolol versus carvedilol versus nonuse | Metoprolol and carvedilol: no survival benefit compared with nonuse; bisoprolol: survival benefit compared with nonuse (HR 0.76) | In HF and COPD, bisoprolol, but not metoprolol or carvedilol, had a dose–response survival benefit | |
| MI | Rasmussen et al. [18] | First-time MI and COPD | β-blocker versus nonuse | β-blocker use associated with lower acute COPD exacerbation risk (adjusted HR 0.78) | β-blocker use not associated with increased acute COPD exacerbation risk following MI, independent of COPD severity, symptom burden, and exacerbation history |
| Wang et al. [33] | First-time acute MI and COPD | Cardioselective or nonselective β-blocker versus nonuse | Cardioselective β-blockers reduced mortality compared with nonuse (HR 0.93); nonselective β-blockers did not increase mortality compared with nonuse (HR 0.98) | β-blockers, particularly cardioselective, improved survival among COPD patients after first MI | |
| Chung et al. [34] | First-time MI and COPD | Bisoprolol versus carvedilol | Cardioselective β-blocker (bisoprolol) had lower incidences of mortality (HR 0.93), major adverse cardiovascular and cerebrovascular events (HR 0.96), HF hospitalization (HR 0.84), and major adverse pulmonary events (HR 0.94) | Cardioselective β-blockers had a lower incidence of severe events than nonselective β-blockers (carvedilol) | |
| Su et al. [49] | Acute MI and COPD | β-blocker versus NDCCB versus control | β-blockers had a lower overall mortality risk (adjusted HR 0.91 versus NDCCBs; 0.88 versus control) and decreased re-hospitalization risk for COPD and other respiratory diseases | β-blockers reduced mortality in COPD after acute MI and did not increase COPD exacerbation risk | |
| AF | Rodríguez-Mañero et al. [42] | AF with/without COPD | β-blocker in patients with versus without COPD | All-cause mortality twofold higher with versus without COPD (28.3% versus 15.5%); β-blocker nonuse independent predictor of all-cause mortality | β-blockers reduced mortality in AF with and without COPD |
| Vlachopoulou et al. [43] | AF and COPD | Cardioselective versus nonselective β-blocker | Cardioselective and nonselective β-blockers had similar all-cause mortality (adjusted HR 1.10), cardiovascular mortality (adjusted HR 1.33), and hospitalization (adjusted HR 1.65) | No difference between cardioselective and nonselective β-blockers in clinical outcomes | |
| Lin et al. [44] | AF and COPD | β-blocker versus CCB | COPD exacerbation risk lower with β-blockers (HR 0.80 versus CCBs); after COPD severity stratification, reduction in exacerbations with β-blockers persisted in mild (HR 0.75) but not severe (HR 0.95) COPD | β-blockers in mild COPD and AF associated with lower exacerbation risk than CCBs; close β-blocker monitoring in severe COPD and AF necessary | |
| Bucci et al. [50] | AF and COPD | β-blocker (selectivity not specified) versus nonuse | Reduced association between COPD and mortality with β-blocker use (HR 0.94) than without β-blocker use (HR 6.23) | β-blockers in COPD and AF associated with a lower mortality risk than without β-blockers |
AF atrial fibrillation, BP blood pressure, CCB calcium channel blocker, COPD chronic obstructive pulmonary disease, CVD cardiovascular disease, FEV1 forced expiratory volume in 1 second, HF heart failure, HFrEF heart failure with reduced ejection fraction, HR hazard ratio, LVEF left ventricular ejection fraction, MI myocardial infarction, NDCCB nondihydropyridine calcium channel blocker