Role of beta blockers in hypertrophic obstructive cardiomyopathy (HOCM)

Role of beta blockers in hypertrophic obstructive cardiomyopathy (HOCM)

Beta blockers are the mainstay of medical treatment in hypertrophic cardiomyopathy with or without obstruction. They reduce the dynamic left ventricular outflow obstruction, angina, exertional dyspnea and the risk of ventricular arrhythmias [1]. Reduction in left ventricular outflow obstruction is mostly due to the negative inotropic effect of beta blockers [2].

Reduction in heart rate by beta blockers increases diastolic filling time. Sympatholytic effect of beta blockade can also reduce ventricular stiffness. Non-vasodilating beta blockers titrated to maximum tolerated dose is considered for those with symptomatic left ventricular outflow obstruction. This is mostly on the basis of expert consensus rather than clinical trial data [3].

References

1. Houston BA, Stevens GR. Hypertrophic cardiomyopathy: a review. Clin Med Insights Cardiol. 2015 Jan 26;8(Suppl 1):53-65. doi: 10.4137/CMC.S15717. PMID: 25657602; PMCID: PMC4309724.
2. Cabrera-Bueno F, García-Pinilla JM, Gómez-Doblas JJ, Montiel-Trujillo A, Rodríguez-Bailón I, de Teresa-Galván E. Beta-blocker therapy for dynamic left ventricular outflow tract obstruction induced by exercise. Int J Cardiol. 2007 Apr 25;117(2):222-6. doi: 10.1016/j.ijcard.2006.04.080. Epub 2006 Jul 17. PMID: 16844244.
3. Authors/Task Force members, Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014 Oct 14;35(39):2733-79. doi: 10.1093/eurheartj/ehu284. Epub 2014 Aug 29. PMID: 25173338.