Differential Effect of β-Blockers for Heart Rate Control in Coronary Artery Disease

Background: Resting heart rate is an independent risk factor for cardiovascular disease and is mainly controlled by beta-blockers (BBs). BBs are part of the optimal medical treatment for coronary artery disease (CAD), and their benefit correlates with resting heart rate (RHR) reduction. Hypothesis: RHR is poorly controlled in daily practice among patients with stable cardiovascular disease, and control is only achieved by some BBs. Methods: Observational, cross-sectional, and multicenter study of CAD patients recruited nationwide from 20 institutions. Antecedents, risk factors, and treatments were collected. Controlled RHR was considered at < 70 bpm. Results: The mean age of the 2897 patients included was 67.4 years (11.4%), and 75.9% were males. Patients treated with a BB (56.5%) had a lower mean age and comorbidities. The mean RHR was 69.6 bpm (12.6). A significantly lower RHR was observed in patients treated with a BB compared to the rest (67.2 vs 73.0 bpm; P< 0.01), and no difference was observed in patients treated with a calciumchannel blocker (CCB). The analysis by individual agents identified that only patients treated with atenolol, bisoprolol, and metoprolol had significantly lower RHR than those not receiving a BB. No differences were observed in mean doses of each agent according to RHR control, except for verapamil. BB treatment was independently associated with RHR control (odds ratio [OR]: 2.42, 95% CI: 2.05-2.87; P < 0.01), and no association was found for nondihydropyridine CCBs (OR: 0.99, 95% CI: 0.96-1.02; P = 0.38). Bisoprolol (OR: 1.56, 95% CI: 1.38-1.78; P< 0.01), atenolol (OR: 2.01, 95% CI: 1.57-3.49; P< 0.01), and metoprolol (OR: 1.29, 95% CI: 1.04-1618; P = 0.04) were independently associated with RHR control. Conclusions: RHR is poorly controlled in CAD patients, and although BBs are the most efficient therapy, in daily clinical practice RHR < 70 bpm is only independently associated with atenolol, bisoprolol, or metoprolol.