Beta-blockers for pericarditis – what's the evidence?

The use of beta-blockers, on top of standard anti-inflammatory therapies, may improve symptom control in patients with pericarditis, according to a recent study.

Compared with patients receiving anti-inflammatory therapy alone, patients treated with beta-blockers plus standard anti-inflammatory therapy had a reduction in basal heart rate (–21 percent vs –7 percent; p<0.001). Additionally, they had a lower frequency of symptoms at 3 weeks (4 percent vs 14 percent; p=0.024). At 18 months, there was also a trend toward less pericarditis recurrence in patients using beta-blockers. [Am J Cardiol 2021;doi:10.1016/j.amjcard.2021.01.032]

Symptoms of pericarditis typically include sudden onset of sharp chest pain, which may also be felt in the shoulders, neck, or back. “Pericardial pain is triggered and worsened by the friction of inflamed pericardial layers,” said study author Dr Massimo Imazio, a cardiologist at Maria Vittoria Hospital in Turin, Italy.

Exercise restriction to control the heart rate is the recommended nonpharmacological therapy for patients. “The reduction in heart rate could be helpful to better control the symptoms by reducing the friction of inflamed pericardial layers and thus mechanical inflammation,” he added. 

Up to 15 percent of patients with pericarditis experience multiple recurrences. The first-line therapy for recurrent pericarditis includes aspirin/nonsteroidal anti-inflammatory drugs plus colchicine. [Cardiol Res Pract 2019; 2019:1348364] However, the use of beta-blockers in pericarditis is poorly known.

Imazio and team sought to evaluate the efficacy of beta-blockers and standard anti-inflammatory therapy vs standard anti-inflammatory therapy alone in controlling symptoms in 347 patients with pericarditis (mean age 53 years, 58 percent female, 48 percent with recurrent pericarditis, 81 percent with idiopathic/viral aetiology) who were referred to their centre.

Propensity score matching was used for comparison and clinical and echocardiographic follow-up was done at 3 weeks, 1, 3, and 6 months, and every 12 months. Outcomes included persistence of pericardial pain at week 3 and recurrence of pericarditis at 18 months.

In the full cohort, 36.9 percent were taking beta-blockers. Peak C-reactive protein values were correlated with the heart rate on first observation (p<0.001).

Over time, pericarditis can result in chronic inflammation with thickening and, ultimately, calcification of the pericardium. “In symptomatic patients with pericarditis and heart rate of more than 75 beats/min, empiric use of beta-blockers, on top of anti-inflammatory therapies, allow pharmacological control of pericardial pain,” said Imazio.  

More studies are warranted to verify the efficacy of beta-blockers in this setting.