Objective To systematically review the influence of tight heart rate (HR) control on the efficacy of perioperative β-blockade, and discuss the effective measures of perioperative myocardial protection. Methods We searched the PubMed, OVID, EMbase, the Cochrane Library and Chinese Biomedical Database (CBM) for randomized controlled trials on evaluating perioperative β-blockers after noncardiac surgery. The quality of the included studies was evaluated by the method recommended by the Cochrane Collaboration. Meta-analyses was conducted by using the Cochrane Collaboration’s RevMan software. Results Thirteen RCTs including 11 590 patients were included. The combined results of all studies showed cardioprotective effect of β-blockers (OR=0.64, 95%CI 0.50 to 0.80, P=0.000 1), with considerable heterogeneity among the studies (I2=57%). However, grouping the trials on the basis of maximal HR showed that trials where the estimated maximal HR was 100 bpm were associated with cardioprotection (OR=0.37, 95%CI 0.26 to 0.52, Plt;0.000 01) whereas trials where the estimated maximal HR was 100 bpm did not demonstrate cardioprotection (OR=1.13, 95%CI 0.81 to 1.59, P=0.48) with no heterogeneity (I2=0%). Conclusion The evidence suggests that effective control of HR is important for achieving cardioprotection and that administration of β-blockers does not reliably decrease HRs in all patients. Judicious use of combination therapy with other drugs may be necessary to achieve effective postoperative control of HR.
We correct some misunderstandings of hypertension therapy and update the knowledge of hypertensive drugs by reviewing the progress of evidence-based research of hypertension in 2004.
ObjectiveTo compare the effectiveness of different β-blockers for preventing postoperative atrial fibrillation (POAF) after cardiac surgery. Methods Databases of PubMed, Science Direct, Web of Science, The Cochrane Library, SinoMed, CKNI, VIP, WanFang were searched by the computer from inception to April 31, 2022 to collect randomized controlled studies on the comparison of the effectiveness of different β-blockers for preventing POAF. Two investigators independently screened the literature and extracted information. The quality of the literature was evaluated using Cochrane bias risk tool, and RevMan 5.3 and STATA 17.0 were used for meta-analysis. Results A total of 17 randomized controlled studies with 3 290 patients were included. Direct meta-analysis showed that landiolol and metoprolol were more effective than placebo (P≤0.001), and carvedilol was more effective than metoprolol in preventing the development of POAF (P<0.001). Network meta-analysis showed that landiolol, carvedilol and metoprolol were more effective than placebo in preventing the incidence of POAF (P<0.05). Landiolol and carvedilol were more effective than metoprolol, and carvedilol were more effective than nebivolol (P<0.05). The surface under the cumulative ranking curve from high to low were carvedilol, landilol, propranolol, atenolol, metoprolol, and nebivolol. Conclusion Carvedilol and landilol have different degrees of improvement in the occurrence of POAF, and carvedilol has the best preventive effect. More studies are required to verify the strength of evidence due to the limited sample size.