543
Volume 5, Issue 10: Special Issue
(EJAR)
ISSN: 2181-2020
MPHAPP
THE 6TH INTERNATIONAL SCIENTIFIC AND PRACTICAL
CONFERENCE
“
MODERN PHARMACEUTICS: ACTUAL
PROBLEMS AND PROSPECTS
”
TASHKENT, OCTOBER 17, 2025
in-academy.uz
MODERN APPROACHES TO THE USE OF BETA-BLOCKERS IN CLINICAL
PHARMACOLOGY
Molaikhanov Sh.A.
Rustamkhanov D.R.
Shakirov M.A.
Assistant at the Department of Pharmacology, Kazakh National Medical University named
after S.D. Asfendiyarov, Almaty, Republic of Kazakhstan
e-mail: molaykhanov96@mail.ru , tel.: +7 (747) 436-95-39
https://doi.org/10.5281/zenodo.17344140
Introduction.
Cardiovascular diseases (CVDs) remain the leading cause of mortality
worldwide and in the Republic of Kazakhstan. According to the World Health Organization (WHO),
more than 17.9 million people die from CVDs every year (WHO, 2021). In Kazakhstan, the
prevalence of arterial hypertension among the adult population exceeds 25%, which makes its control
particularly relevant (Ministry of Health of the Republic of Kazakhstan, 2022).
One of the key classes of drugs for the treatment of CVDs are beta-blockers (BBs), which have
been used for more than 50 years and play an important role in the therapy of arterial hypertension,
ischemic heart disease (IHD), chronic heart failure (CHF), and cardiac arrhythmias. Despite the
accumulated clinical experience, discussions continue regarding the rationality of their widespread
use, the choice of a particular drug, and its combinations with other therapeutic agents.
Pharmacological features
BBs are a heterogeneous class of drugs differing in their selectivity for β1- and β2-
adrenoreceptors, vasodilating properties, and metabolic effects.
Non-selective BBs
(propranolol, nadolol) block both receptor types but may cause
bronchospasm and impair glucose metabolism.
Cardioselective BBs
(bisoprolol, metoprolol, atenolol) predominantly affect β1-receptors of
the myocardium, providing antianginal and antihypertensive effects with a lower risk of
bronchospasm.
Third-generation BBs
(carvedilol, nebivolol) have additional vasodilating and endothelium-
protective properties, improving tolerability in patients with metabolic syndrome and diabetes
mellitus.
The mechanism of action of BBs includes reducing heart rate, decreasing myocardial
contractility, and suppressing the activity of the renin–angiotensin–aldosterone system.
Clinical efficacy
Large multicenter trials have proven the effectiveness of BBs in reducing mortality and
hospitalizations in patients with CHF and IHD. In the MERIT-HF and CIBIS-II studies, bisoprolol
and metoprolol reduced mortality risk by 34% and hospitalization risk by 32% (MERIT-HF, 1999;
CIBIS-II, 1999). In the COPERNICUS trial, carvedilol demonstrated a 35% reduction in mortality
(COPERNICUS, 2002).
Regarding arterial hypertension, Cochrane meta-analyses (2020) and studies by Lindholm et al.
(2017) showed that BBs are less effective in stroke prevention compared with calcium channel
blockers or angiotensin-converting enzyme (ACE) inhibitors. Nevertheless, their role remains critical
in cases of hypertension combined with IHD, tachyarrhythmias, and CHF.
Safety and tolerability
544
Volume 5, Issue 10: Special Issue
(EJAR)
ISSN: 2181-2020
MPHAPP
THE 6TH INTERNATIONAL SCIENTIFIC AND PRACTICAL
CONFERENCE
“
MODERN PHARMACEUTICS: ACTUAL
PROBLEMS AND PROSPECTS
”
TASHKENT, OCTOBER 17, 2025
in-academy.uz
The main adverse effects of BBs include bradycardia, hypotension, fatigue, and disturbances
of lipid and glucose metabolism. Non-selective drugs are contraindicated in patients with bronchial
asthma and chronic obstructive pulmonary disease (COPD). Modern cardioselective and vasodilating
BBs have a better safety profile.
In diabetic patients, preference should be given to nebivolol and carvedilol, as they have less
impact on insulin resistance and glucose metabolism.
Perspectives of use
Modern research focuses on the individualization of therapy, taking into account the
pharmacogenetic characteristics of patients. There is also increasing interest in combination therapy,
where BBs are used together with ACE inhibitors, calcium antagonists, and diuretics. Third-
generation drugs such as nebivolol demonstrate additional pleiotropic effects, including antioxidant
and endothelium-protective properties, which expand their therapeutic potential.
Conclusion
Beta-blockers remain a cornerstone in the treatment of cardiovascular diseases. Their rational
use requires consideration of the clinical picture, comorbidities, and individual drug tolerability.
Promising directions include personalized medicine, pharmacogenetic approaches, and the further
study of combination therapy with new-generation BBs.
