Beta-blockers

Abstract

While β-blockers have become a cornerstone for treatment of hypertension and heart failure in adults, recommendations from the literature regarding the use of these medications in infant, children, and adolescent patients are still largely variable. Additionally, differences in the etiology of heart failure between adult and pediatric patients make it difficult to extrapolate adult data and recommendations to the pediatric population. Despite these differences, there is evidence that pediatric and adult patients experience similar alterations to the neuroendocrine axis during heart failure, indicating a place in therapy for β-blockers [1]. β-Blockers have shown some benefit in pediatric patients with hypertension, but should not be used as first-line therapy [2, 3]. Attention must be paid to the individual properties (cardioselectivity, intrinsic sympathomimetic activity, alpha-adrenergic antagonism, lipophilicity) when choosing an agent [4]. Therapy should be initiated with low doses and titrated slowly to avoid adverse effects [5].