Abstract :
PURPOE: To preent an evidence-baed review of the ytemic advere effect of beta-adrenergic blocker and recommend afety guideline for ue of ophthalmic beta-adrenergic blocker.
DEIGN: Literature review of publihed article in peer-reviewed journal and medical text.
METHOD: Pre-MEDLINE and MEDLINE earch of relevant Englih language article from 1966 to the preent. Cardiovacular, pulmonary, endocrine/metabolic, central nervou ytem, exual, exercie, and neuromucular effect of ytemic or ophthalmic beta-adrenergic blocker were reviewed.
REULT: ytemic beta-adrenergic antagonit unequivocally reduce mortality in patient with mild, moderate, and even evere congetive heart failure. Development of ymptomatic bradycardia on ytemic or ophthalmic beta-adrenergic blocker alone likely indicate underlying cardiac conduction diturbance. Beta 2-adrenergic blockade, regardle of route of adminitration, may exacerbate or trigger bronchopam in patient with athma or pulmonary dieae aociated with hyper-reactive airway. Thi review identifie no cientific tudie upporting the development of worening claudication, depreion, hypoglycemic unawarene, or prolonged hypoglycemia in non-inulin-dependent diabete, exual dyfunction, or impaired neuromucular tranmiion with ytemic or ophthalmic beta-adrenergic blocker.
CONCLUION: Many commonly preumed advere beta-adrenergic blocker effect oberved via ytemic or ocular adminitration are not upported by publihed randomized clinical trial. Wide acceptance of uch traditionally purported ide effect ha been largely due to propagation of iolated cae report and hort erie a well a peronal communication felt to reflect expert opinion. Many more patient may be eligible to ue thee drug. Obtaining a careful medical hitory and checking pule rate and rhythm in the office hould identify the vat majority of patient with potential cardiopulmonary contraindication
