MedWorm: Beta-Blockers

Effects of renin-angiotensin blockers/inhibitors and statins on mortality and functional impairment in polypathological patients.

European Journal of Internal Medicine — Fri, 03 Feb 2012 00:26:12 +0100

CONCLUSIONS: The prescription of statins, alone or in combination with other drugs, may impact the survival and functional decline in polypathological patients. Further prospective blinded randomised assays are needed to confirm these observations. PMID: 22284251 [PubMed - in process] (Source: European Journal of Internal Medicine)

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Effects of Candesartan on Left Ventricular Function, Aldosterone and BNP in Chronic Heart Failure

Cardiovascular Drugs and Therapy — Thu, 02 Feb 2012 18:16:26 +0100

Conclusions In CandHeart, the addition of candesartan to standard medical treatment did not reduce circulating BNP more than standard therapy (primary endpoint), but it significantly improved LV function and produced a marked decrease in aldosterone levels at study end. Content Type Journal ArticlePages 1-13DOI 10.1007/s10557-012-6370-8Authors Aneta Aleksova, Cardiovascular Department, “Ospedali Riuniti” and University of Trieste, Trieste, ItalySerge Masson, Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche “Mario Negri”, via Giuseppe La Masa 19, 20156 Milan, ItalyAldo P. Maggioni, ANMCO Research Center, Florence, ItalyDonata Lucci, ANMCO Research Center, Florence, ItalyRenato Urso, ANMCO Research Center, Florence, ItalyLidia Staszew...

Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction [PAPERS]

The British Journal of Psychiatry — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions All-cause mortality following an acute myocardial infarction is greatest in patients with depression who are insufficiently treated and is a risk in patients with treatment-resistant depression. However, the risk of mortality associated with treatment-resistant depression is partly explained by comorbid disorders. Further studies are warranted to determine whether changes in depression independently predict all-cause mortality. (Source: The British Journal of Psychiatry)

Pharmacist intervention in primary care to improve outcomes in patients with left ventricular systolic dysfunction

European Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion A low-intensity, pharmacist-led collaborative intervention in primary care resulted in modest improvements in prescribing of disease-modifying medications but did not improve clinical outcomes in a population that was relatively well treated at baseline. (Source: European Heart Journal)

Guidelines for the diagnosis and management of Catecholaminergic Polymorphic Ventricular Tachycardia

Heart, Lung and Circulation — Wed, 01 Feb 2012 05:00:00 +0100

Background: Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is an inherited arrhythmia syndrome, characterised by polymorphic ventricular tachycardia induced by adrenergic stress. CPVT can be caused by mutations the cardiac ryanodine receptor gene (RYR2) or mutations in the cardiac calsequestrin gene CASQ2. Structural heart disease is usually absent and the baseline ECG is usually normal. Patients with CPVT often present with exercise- or emotion induced syncope, the first presentation can also be sudden cardiac death.Management: Besides removal of triggers treatment with beta blockers is currently a class I indication in clinically diagnosed patients. Beta blockage should be titrated up to an effective level. The addition of flecainide seems to be a promising approach in pati...

Adherence with Migraine Prophylaxis in Clinical Practice

Pain Practice — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion: Our findings suggest that many patients who begin migraine prophylaxis with antidepressants, antiepileptics, or beta blockers are no longer taking these medications at 6 months. (Source: Pain Practice)

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Laryngoscopy in conscious patients with remifentanil: how useful is an “awake look”?

Journal of Clinical Anesthesia — Sun, 29 Jan 2012 12:15:49 +0100

Conclusions: Using remifentanil as the sole analgesic allows evaluation of the larynx with direct laryngoscopy in a conscious patient. A poor Cormack-Lehane grade in a conscious patient may or may not improve with general anesthesia. (Source: Journal of Clinical Anesthesia)

The risk of elevated resting heart rate on the development of type 2 diabetes in patients with clinically manifest vascular diseases.

European Journal of Endocrinology — Fri, 27 Jan 2012 05:00:00 +0100

Conclusions. Increased RHR, a reflection of sympathetic nerve activity, is associated with an increased risk for T2DM in patients with manifest vascular diseases, particularly in middle-aged patients. PMID: 22285702 [PubMed - as supplied by publisher] (Source: European Journal of Endocrinology)

Patient Management After Noninvasive Cardiac Imaging: Results From SPARC (Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in Coronary Artery Disease)

Journal of the American College of Cardiology — Thu, 26 Jan 2012 13:57:11 +0100

Conclusions: Overall, noninvasive testing had only a modest impact on clinical management of patients referred for clinical testing. Although post-imaging use of cardiac catheterization and medical therapy increased in proportion to the degree of abnormality findings, the frequency of catheterization and medication change suggests possible undertreatment of higher risk patients. Patients were more likely to undergo cardiac catheterization after computed tomography angiography than after single-photon emission computed tomography or positron emission tomography after normal/nonobstructive and mildly abnormal study findings. (Study of Perfusion and Anatomy's Role in Coronary Artery [CAD] [SPARC]; NCT00321399) (Source: Journal of the American College of Cardiology)

Topical beta-blocker treatment for migraine

International Ophthalmology — Wed, 25 Jan 2012 18:07:46 +0100

Abstract Beta-blockers are a well-known prophylactic treatment for migraine; however, treatment by the ocular route has not been widely considered. This case illustrates the resolution of a visual field defect associated with migraine and improvement of symptoms possibly due to administration of a topical beta-blocker. This novel method of treatment especially when visual field defects are present may have a place in the management of migraine. Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s10792-012-9516-6Authors Patrick J. T. Chiam, Eye Unit, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire HP21 8AL, UK Journal International OphthalmologyOnline ISSN 1573-2630Print ISSN 0165-5701 (Source: International Ophthalmology)

Pharmacological interventions in the treatment of the acute effects of Cannabis: a systematic review of literature

Harm Reduction Journal — Wed, 25 Jan 2012 05:00:00 +0100

Conclusion: Although scarce, the evidence on pharmacological interventions for the management of cannabis intoxication suggests that propanolol and rimonabant are the most effective compounds currently available to treat the physiological and subjective effects of the drug. Further studies are necessary to establish the real effectiveness of these two medications, as well as the effectiveness of other candidate compounds to counteract the effects of cannabis intoxication, such as cannabidiol and flumazenil. (Source: Harm Reduction Journal)

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Postmenopausal Women with Constipation and Cardiovascular Disease

The American Journal of Medicine — Mon, 23 Jan 2012 23:45:01 +0100

This study clearly documents the distribution of the many cardiovascular risk factors, such as smoking and diabetes. Although the study does document the use of symptomatic medications such as diuretics and calcium channel blockers, it would be helpful to know the distribution of mortality-reducing medications in post-cardiovascular injury, such as angiotensin-converting enzyme inhibitors, beta-blockers, and aspirin. (Source: The American Journal of Medicine)

The Reply

The American Journal of Medicine — Mon, 23 Jan 2012 23:45:01 +0100

We would like to thank Salamon et al for their interest in our article. They raise 2 very interesting points. The first is the distribution of medications known to affect cardiovascular mortality, such as statins, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and aspirin in our study population, and the possible impact that these variables might have on our results when included in the multivariate analysis. The distributions of baseline use of ACE inhibitors, beta-blockers, aspirin, and statins by constipation category are shown in the . The prevalence of use of these medications was slightly higher with more severe constipation, although this may be due to age—because both constipation severity and medication use increase with age. Overall, the prevalence of statin use...

Research suggests beta-blockers should be continued peri-operatively

NeLM - News — Mon, 23 Jan 2012 05:00:00 +0100

Source: Archives of Surgery Area: News According to the results of research published early online in the Archives of Surgery, beta-blockers should be continued peri-operatively, including on the day of surgery, to avoid cardiac complications. The authors note that studies to date examining beta-blocker withdrawal have had small sample sizes, have been conducted in a limited number of settings, and have focused on patients undergoing vascular or cardiac procedures. The purpose of their study was to evaluate the relationship among the continuation of beta-blockers, survival, and cardiac complications in elective colorectal and bariatric surgical procedures. They used data from the Washington's Surgical Care and Outcomes Assessment Program, a prospectively gather...

{beta}-blockers associated with reduced all-cause mortality in COPD

Evidence-Based Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Context Chronic obstructive pulmonary disease (COPD) is currently recognised as an inflammatory disease associated with significant extrapulmonary effects and important comorbidities, including ischaemic heart disease and heart failure.1 Despite ample evidence of the benefits of β-blockers in hypertension, ischaemic heart disease and congestive heart failure, use of β-blockers is >50% lower in heart failure patients with than without COPD,2 probably because of concern regarding the possibility of bronchospasm provoked by β-blockers in patients with underlying obstructive lung disease, despite evidence to the contrary.3 In view of the compelling evidence demonstrating beneficial effects of β-blockers in cardiovascular disease (CVD), including improved survival, failur...

Therapeutic approach for patients with catecholaminergic polymorphic ventricular tachycardia: state of the art and future developments

Europace — Fri, 20 Jan 2012 05:00:00 +0100

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmia syndrome characterized by bidirectional or polymorphic ventricular arrhythmias under conditions of increased sympathetic activity in young patients with structurally normal hearts. Patients with CPVT are at high risk of developing life-threatening ventricular arrhythmias when untreated. A wide variety of arrhythmic event rates on conventional therapy, with β-blockers as the cornerstone, has been reported. Here, we systematically review all available studies describing the efficacy of β-blocker therapy for prevention of arrhythmic events in CPVT. Because of heterogeneity between the studies, a random-effects meta-analysis model was used to assess the efficacy of β-blocker therapy in preven...

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Trends in isolated coronary artery bypass grafting: An analysis of the Society of Thoracic Surgeons adult cardiac surgery database

The Journal of Thoracic and Cardiovascular Surgery — Thu, 19 Jan 2012 09:10:16 +0100

Conclusions: Over the past decade, the risk profile of patients undergoing CABG has changed, with fewer smokers, more diabetic patients, and better medical therapy characterizing patients referred for surgical coronary revascularization. The left internal thoracic artery is nearly universally used and outcomes have improved substantially, with a significant decline in postoperative mortality and morbidity. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Exanthematous drug eruption due to valsartan.

Cutaneous and Ocular Toxicology — Wed, 18 Jan 2012 05:00:00 +0100

Discussion and conclusion: Most common antihypertensive agents including diuretics, beta blockers, calcium-channel blockers, angiotensin-converting enzyme inhibitors have many cutaneous side effects. However, there are a few reports about the cutaneous side effects of ARBs. Physicians should be aware of the cutaneous side effects of this commonly used agent and valsartan should be considered as a triggering factor of an exanthematous drug reactions. PMID: 22257082 [PubMed - as supplied by publisher] (Source: Cutaneous and Ocular Toxicology)

SMC does not recommend ranolazine (Ranexa®) as an add-on for stable angina

NeLM - Drug Specific Reviews — Tue, 17 Jan 2012 05:00:00 +0100

Source: Scottish Medicines Consortium (SMC) Area: Evidence > Drug Specific Reviews Following consideration of a second resubmission, the Scottish Medicines Consortium (SMC) does not recommend the use of ranolazine (Ranexa®) within NHS Scotland as an add-on therapy for the symptomatic treatment of patients with stable angina pectoris who are inadequately controlled or intolerant to first-line antianginal therapies (such as beta-blockers and/or calcium antagonists). The drug advice summarises the efficacy, safety and cost-effectiveness data submitted by the company and considered by the Committee (please see the link below for details). This notes that the addition of ranolazine to standard doses of antianginal drugs resulted in a modest increase in exercise duration a...

Effects of the long-term administration of nebivolol on the clinical symptoms, exercise capacity, and left ventricular function of patients with diastolic dysfunction: results of the ELANDD study

European Journal of Heart Failure — Tue, 17 Jan 2012 05:00:00 +0100

Conclusions Compared with placebo, 6 months treatment with nebivolol did not improve exercise capacity in patients with HFPEF. Its negative chronotropic effect may have contributed to this result. (Source: European Journal of Heart Failure)

Glomerular Filtration Rate Estimated by the CKD-EPI Formula is a Powerful Predictor of In-Hospital Adverse Clinical Outcomes After an Acute Coronary Syndrome

Angiology — Mon, 16 Jan 2012 05:00:00 +0100

The prognostic value of admission estimated glomerular filtration rate (eGFR) calculated by the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula for cardiovascular adverse outcomes in acute coronary syndrome (ACS) was explored. Baseline eGFR was classified as no renal dysfunction (>90 mL/min per 1.73 m2), borderline (90-60.1 mL/min per 1.73 m2), moderate (60-30.1 mL/min per 1.73 m2), or severe (≤30 mL/min per 1.73 m2) renal dysfunction. Of the 5034 patients, 3415 (67.8%) had eGFR <90. Compared to patients with an eGFR ≥60 mL/min per 1.73 m2, patients with <60 mL/min per 1.73 m2 were less likely to be treated with β-blockers, angiotensin-converting enzyme inhibitors, or statins, or to undergo percutaneous coronary interventions. Lower eGFR showed a...

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{beta}-Blocker Continuation After Noncardiac Surgery: A Report From the Surgical Care and Outcomes Assessment Program [Original Article]

Archives of Surgery — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions β-Blocker continuation on the day of and after surgery was associated with fewer cardiac events and lower 90-day mortality. A focus on β-blocker continuation is a worthwhile quality improvement target and should improve patient outcomes. (Source: Archives of Surgery)

Preinjury Beta Blocker Usage does not Affect the Heart Rate Response to Initial Trauma Resuscitation

Journal of Surgical Research — Sat, 14 Jan 2012 22:30:13 +0100

(Source: Journal of Surgical Research)

Does Selective Beta 1 Blockade Provide Bone Marrow Protection Following Trauma/Hemorrhagic Shock?

Journal of Surgical Research — Sat, 14 Jan 2012 22:30:00 +0100

Introduction: Severe trauma and its associated hypercatecholemine state lead to bone marrow (BM) dysfunction. Previously, non-selective beta blockade with propranolol demonstrated a dose-dependent protection of the BM which was associated with a decrease in heart rate. As selective beta blockade is commonly used clinically, the aim of this study is to more clearly define the role of the specific beta adrenergic receptors (B1, B2, B3) in BM protection following trauma and hemorrhagic shock. Methods: Male Sprague-Dawley Rats (N=4-6/group) underwent unilateral lung contusion (LC) via blast wave percussion followed by hemorrhagic shock (HS) to a mean arterial pressure (MAP) of 30-35mmHg for 45 minutes. Animals were resuscitated with shed blood. Following resuscitation, animals were injected wi...

Beta Adrenergic Antagonists in Sepsis: Effects on Survival in A Murine Model

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:13 +0100

Introduction: Distinct from their actions on the cardiovascular system, beta-blockers also have profound effects on modulation of the inflammatory response and metabolism. However, sepsis-induced myocardial depression has resulted in clinical avoidance of beta-blockers as treatment in severe sepsis. Potential benefits of beta-blockade in severe sepsis include blunting activation of the sympathetic nervous system resulting in decreased myocardial oxygen demand as well as modulation of the immune response. the purpose of this study was to examine the effect of beta-1 selective blockade on survival after endotoxemia. We hypothesized that beta-1 selective blockade initiated after septic insult would prolong survival in a murine model. Methods: 8-12 week old C57BL/6J male mice underwent intra-p...

Aldosterone, mortality, and acute ischaemic events in coronary artery disease patients outside the setting of acute myocardial infarction or heart failure

European Heart Journal — Sat, 14 Jan 2012 05:00:00 +0100

Conclusion Our results demonstrate that, in patients with CAD but without heart failure or acute MI, the level of aldosterone is strongly and independently associated with mortality and the occurrence of acute ischaemic events. (Source: European Heart Journal)

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Long‐term use of drugs affecting the renin‐angiotensin system and the risk of cancer. A population‐based case‐control study.

British Journal of Clinical Pharmacology — Fri, 13 Jan 2012 05:00:00 +0100

Conclusion: The indication or possibly threshold for prescribing antihypertensives appears to be related to a small increase in cancer risk. The ARB‐cancer association is probably too weak to be addressed in observational studies, given their limitations.© 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society (Source: British Journal of Clinical Pharmacology)

Case control study: Antihypertensive drugs and risk of incident gout among patients with hypertension

NeLM - News — Thu, 12 Jan 2012 05:00:00 +0100

Source: BMJ Area: News The authors of this nested case control study aimed to determine the independent associations of antihypertensive drugs with the risk of incident gout among people with hypertension. The authors note that some particular antihypertensive drugs (such as beta blockers) have been shown to increase the levels of serum uric acid and hence may contribute to the risk of gout. However, others (such as calcium channel blockers and losartan) have been found to lower serum uric acid levels, carrying the potential to lower the risk of gout. They analysed a cohort of 24,768 people with newly diagnosed gout (incident cases) and 50,000 random matched controls from the UK general practice database. This database contains computerised medical records entered by general practitioners...

Ivabradine in combination with beta-blocker improves symptoms and quality of life in patients with stable angina pectoris: results from the ADDITIONS study

Clinical Research in Cardiology — Tue, 10 Jan 2012 06:40:58 +0100

Conclusion In daily clinical practice, combining ivabradine with beta-blocker not only reduces heart rate, number of angina attacks, and nitrate consumption, but also improves the quality of life in patients with stable angina pectoris. Content Type Journal ArticleCategory Original PaperPages 1-9DOI 10.1007/s00392-011-0402-4Authors Karl Werdan, Department of Medicine III, University Hospital Halle (Saale) of the Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097 Halle (Saale), GermanyHenning Ebelt, Department of Medicine III, University Hospital Halle (Saale) of the Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097 Halle (Saale), GermanySebastian Nuding, Department of Medicine III, University Hospital Halle (Saale) of the ...

GRK2 Inhibition in Heart Failure: Something Old, Something New.

Current Pharmaceutical Design — Tue, 10 Jan 2012 05:00:00 +0100

Authors: Lymperopoulos A, Rengo G, Koch WJ Abstract Despite significant advances in pharmacological and clinical treatment, heart failure (HF) remains the number one killer disease in the western world. HF is a chronic and progressive clinical syndrome mainly characterized by reduction in left ventricular ejection fraction and adverse remodeling of the myocardium. One of its hallmark molecular abnormalities is elevation of cardiac G proteincoupled receptor (GPCR) kinase (GRK)-2, originally termed beta-adrenergic receptor kinase-1 (βARK1), a member of the GRK family of serine/threonine protein kinases which phosphorylate and desensitize GPCRs. Up-regulated GRK2 in the heart underlies the diminished contractile responsiveness of the heart to positive inotropes, as it abrogates the p...

Serum Potassium Levels and Mortality in Acute Myocardial Infarction [Original Contribution]

JAMA — Tue, 10 Jan 2012 05:00:00 +0100

Conclusion Among inpatients with AMI, the lowest mortality was observed in those with postadmission serum potassium levels between 3.5 and <4.5 mEq/L compared with those who had higher or lower potassium levels. (Source: JAMA)

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Monocytes on the Scar's Edge⁎

Journal of the American College of Cardiology — Wed, 04 Jan 2012 18:27:40 +0100

During the last decades, intensive investigation has revealed diverse pathophysiological mechanisms of adverse remodeling after myocardial infarction (MI), leading to several therapeutic approaches in clinical care of patients after MI. As a consequence, improved clinical management has significantly lowered morbidity and mortality. Despite major advances in pharmacological treatment of remodeling, such as the introduction of angiotensin-converting enzyme inhibitors () and beta-blockers (), patients surviving an MI are still facing the development of heart failure. Most basic and clinical science heart failure studies have focused so far on the remodeling phase, neglecting the importance of early wound healing after MI for the development of a competent infarct scar and subsequently for cl...

The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting.

Annals of Cardiac Anaesthesia — Sun, 01 Jan 2012 05:00:00 +0100

This study was designed to study the efficacy of intravenous dexmedetomidine for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation in patients with coronary artery disease. Sixty adult patients scheduled for elective off-pump coronary artery bypass surgery were randomly allocated to receive dexmedetomidine (0.5 mcg/kg) or normal saline 15 min before intubation. Patients were compared for hemodynamic changes (heart rate, arterial blood pressure and pulmonary artery pressure) at baseline, 5 min after drug infusion, before intubation and 1, 3 and 5 min after intubation. The dexmedetomidine group had a better control of hemodynamics during laryngoscopy and endotracheal intubation. Dexmedetomidine at a dose of 0.5 mcg/kg as 10-min infusion was administered prio...

Managing hypertension among nursing-home residents and community-dwelling elderly in Germany: a comparative pharmacoepidemiological study

European Journal of Clinical Pharmacology — Fri, 30 Dec 2011 07:09:48 +0100

Conclusions NH residents showed better BP control than CD elderly while receiving less antihypertensive drugs. The prescription of antihypertensives was assumed to be more cost effective in NH. Nevertheless, inappropriate drug use is still high (NH > CD), and there is an extended need for professional medication assessment in both groups of elderly. Content Type Journal ArticleCategory Pharmacoepidemiology and PrescriptionPages 1-9DOI 10.1007/s00228-011-1195-0Authors Sophie Lochner, Institute of Clinical Pharmacology, Medical Faculty, Technical University of Dresden, Fiedlerstrasse 27, D - 01307 Dresden, GermanyWilhelm Kirch, Institute of Clinical Pharmacology, Medical Faculty, Technical University of Dresden, Fiedlerstrasse 27, D - 01307 Dresden, GermanyChri...

Pediatric Autonomic Testing: Retrospective Review of a Large Series

Clinical Pediatrics — Fri, 30 Dec 2011 05:00:00 +0100

Conclusions. Postural tachycardia syndrome was common in this large pediatric population, whereas orthostatic hypotension was infrequent. The symptomatic improvement in the majority bears an unclear relationship to treatment. Prospective studies are needed. (Source: Clinical Pediatrics)

The Impact of COPD on Management and Outcomes of Patients Hospitalized with Acute Myocardial Infarction - A Ten-Year Retrospective Observational Study.

Chest — Thu, 29 Dec 2011 05:00:00 +0100

CONCLUSIONS:Our results suggest that the gap in medical care between patients with and without COPD hospitalized with AMI narrowed substantially between 1997 and 2007. Patients with COPD, however, remain less aggressively treated and are at increased risk for hospital adverse outcomes than patients without COPD in the setting of AMI. Careful consideration is necessary to ensure that these high risk complex patients are not denied the benefits of effective cardiac therapies. PMID: 22207679 [PubMed - as supplied by publisher] (Source: Chest)

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Unstable Angina and Non-ST Elevation Myocardial Infarction.

American Journal of Respiratory and Critical Care Medicine — Wed, 28 Dec 2011 05:00:00 +0100

Authors: Braunwald E Abstract Non ST elevation acute coronary syndromes (NSTE-ACS) are responsible for approximately 1 million admissions to U.S. hospitals and twice as many to European hospitals each year. Thus, it is one of the most common serious illnesses in adults, and it is associated with an in-hospital mortality of approximately 5%. The most common cause is rupture of an atherosclerotic coronary plaque, resulting in subtotal coronary occlusion. Diagnosis is based on the clinical picture of retrosternal chest pain, aided by electrocardiographic findings of ST segment deviations and biomarker abnormalities (elevation of troponin and natriuretic peptides) and cardiac imaging (myocardial scans showing perfusion defects). Treatment involves anti-ischemic agents (nitrates and bet...

Intense Pulsed-Light Therapy for Proliferative Haemangiomas of Infancy

Clinical and Developmental Immunology — Tue, 27 Dec 2011 23:55:03 +0100

Infantile haemangioma therapy has long been a wait-and-see policy. Since recent development of laser and light therapy, pulsed dye laser has been successfully used for treating superficial haemangiomas. Few studies have been published about treatment with intense pulsed light (IPL) to assess the risk/benefit of IPL in the treatment of infantile haemangiomas during their early proliferative phase. In the present retrospective cohort study, we retrieved data about a series of 14 Caucasian children (median age: 4.8 months) with infantile haemangiomas treated with Photoderm Vasculight flash lamp. All patients experienced a rapid regression of the haemangiomas after 3 treatments on average. Few adverse events were noted, including ulceration and crusts. No residual scarring and cosmetic damages...

Interpretation of the Association between Beta-Blockers and Hip/Femur Fracture.

American Journal of Nephrology — Sat, 24 Dec 2011 05:00:00 +0100

Authors: de Vries F, Souverein P PMID: 22205435 [PubMed - as supplied by publisher] (Source: American Journal of Nephrology)

Interpretation of the Association between Beta-Blockers and Hip/Femur Fracture

Karger Publishers — Fri, 23 Dec 2011 23:00:00 +0100

Am J Nephrol 2012;35:101–102 (DOI:10.1159/000334633) (Source: Karger Publishers)

Association between Perchlorate and Indirect Indicators of Thyroid Dysfunction in NHANES 2001-2002, a Cross-Sectional, Hypothesis-Generating Study.

Biomarker Insights — Fri, 23 Dec 2011 12:00:02 +0100

CONCLUSIONS: Although the mean response biomarkers were within normal range, their association with urinary perchlorate is of interest. HGB and HCT among pregnant women showed a stronger association with urinary perchlorate than non-pregnant women age 15-49. Statistically significant associations were observed for individual perchlorate quintiles. Assumption of linearity of log-transformed perchlorate may result in underestimation of some associations. PMID: 22174568 [PubMed - in process] (Source: Biomarker Insights)

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Isolation, characterization, and in vitro propagation of infantile hemangioma stem cells and an in vivo mouse model

Journal of Hematology and Oncology — Thu, 22 Dec 2011 05:00:00 +0100

Conclusions: The ability to propagate large numbers of IH stem cells in vitro and the generation of an in vivo mouse model provides novel avenues for testing IH therapeutic agents in the future. (Source: Journal of Hematology and Oncology)

Acute myocardial infarction in a patient with hypofibrinogenemia: a case report

BioMed Central — Mon, 19 Dec 2011 05:00:00 +0100

Conclusion: Although coronary thrombosis is a rare event in patients with fibrinogen deficiency, this condition is of major interest in view of the difficulties observed in managing these patients. (Source: BioMed Central)

Republished editorial: Navigating adaptive challenges in quality improvement

Postgraduate Medical Journal — Mon, 19 Dec 2011 05:00:00 +0100

Many quality improvement (QI) projects often fail to achieve their goals. Some fail for technical reasons, such as invalid measures, inattention to key contextual factors that determine the intervention's effectiveness, or not pilot testing the effort to identify and remove implementation barriers. But, an even larger number of projects fail because of adaptive challenges. ‘Adaptive challenges can only be addressed through changes in people's priorities, beliefs, habits, and loyalties.’1 2 A challenge for leaders is engaging people in deciding the change is needed, while also accepting that there may be things people want to preserve. For example, convincing physicians to include nurses during patient rounds, but letting them work out the logistics. Technical challenges are iss...

Combined use of high-sensitivity ST2 and NTproBNP to improve the prediction of death in heart failure

European Journal of Heart Failure — Sun, 18 Dec 2011 05:00:00 +0100

Conclusions Our data suggest that in a real-life cohort of HF patients, the addition of ST2 and NTproBNP substantially improves the risk stratification for death beyond that of a model that is based only on established mortality risk factors. (Source: European Journal of Heart Failure)

Risk Stratification for Prevention of Sudden Cardiac Death

Current Treatment Options in Cardiovascular Medicine — Fri, 16 Dec 2011 16:55:05 +0100

Opinion statement Sudden cardiac death (SCD) is a very prevalent cause of death in the United States. The majority of individuals who experience SCD do not survive the episode. Although there are ongoing efforts to improve resuscitation (ie, training in cardiopulmonary resuscitation, easy access to automatic external defibrillators), the primary modality addressing this public health problem is prevention by identification and treatment of high-risk cohorts. Current screening techniques have focused on identifying patients for primary prevention of ventricular tachyarrhythmias. Primary prevention therapies include medications, such as beta-blockers, statins, and angiotensin-converting enzyme inhibitors, and the implantable cardioverter defibrillator (ICD), whose use is cur...

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Betablockers induce cardiac chronotropic incompetence

Journal of Hepatology — Fri, 16 Dec 2011 09:35:54 +0100

We read with great interest the paper by Sersté et al. regarding effects of non-selective beta-blockers (BB) and paracentesis induced circulatory dysfunction (PICD) . This is the first study to explore the background for potential deleterious effects of BB in refractory ascites, as suggested in a previous study by the authors . The high risk of PICD after BB treatment seems related to an inability to increase heart rate during a circulatory challenge. BB bind to β1 and β2-adrenoreceptors and thereby compete with the binding of norepinephrine (NE) and epinephrine. Blocking the β1 receptors reduces the heart rate as well as inotropy and hence the cardiac output even in decompensated patients . (Source: Journal of Hepatology)

European CHMP recommends approval of license extension for ivabradine (Procoralan) as treatment of chronic heart failure (NYHA II to IV) and updates contra-indications

NeLM - News — Fri, 16 Dec 2011 05:00:00 +0100

Source: European Medicines Agency (EMA) Area: News The European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) has recommended the approval of license extension of ivabradine (Procoralan) to include the treatment of chronic heart failure NYHA II to IV with systolic dysfunction, in patients in sinus rhythm and whose heart rate is ? 75 bpm, in combination with standard therapy including beta-blocker therapy or when beta-blocker therapy is contraindicated or not tolerated. The CHMP adopted a new contraindication as follows: . unstable or acute heart failure . pacemaker dependent (heart rate imposed exclusively by the pacemaker) The CHMP also adopted the removal of a contraindication as follows: "heart failure patients with NYHA class III-IV (Source: Ne...

Summary: International Kidney Cancer Symposium

Kidney Cancer Association — Thu, 15 Dec 2011 16:51:59 +0100

Conclusions: Ideal ischemia time is 20-25 minutes or less improves short and long term renal function. >25 minutes carried 5 year risk of new onset stage 4 CKD No differences on GFR for cold vs. warm ischemia times Preoperative GFR and the percent of kidney preserved was a better predictor of post op GFR. No ischemia preserves renal function better than warm. Longer cold ischemia times were equivalent to shorter warm ischemia times. Quality and quantity of the remaining kidney is associated with ultimate renal function. Robotics in RCC Surgery Gennady Bratslavsky, MD The opening question for this presentation was: is there a future for robotic PN? At Society of Urologic Oncology (SUO) 2007 meeting there ...

Beta Blockers for Hypertensives Without Other Comorbidities: Going, Going. . . Gone?

Consultant Live — Tue, 13 Dec 2011 12:00:00 +0100

During my residency in medicine, and for a generation after, beta-blockers were among first choices for lowering blood pressure. Now it seems that beta-blockers have evolved into disreputable antihypertensives. What’s changed over a generation? (Source: Consultant Live)

Beta-blocker therapy is not associated with symptoms of depression and anxiety in patients receiving an implantable cardioverter-defibrillator

Europace — Tue, 13 Dec 2011 05:00:00 +0100

Conclusion In patients receiving an ICD, beta-blocker therapy was not associated with symptoms of anxiety, depression, and ICD concerns. Research is warranted that further elucidates the link between beta-blocker therapy and emotional distress in this vulnerable patient group. (Source: Europace)

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Attenuation of hypertension-mediated glomerulosclerosis in conjunction with increased angiotensin (1-7)

Therapeutic Advances in Cardiovascular Disease — Tue, 13 Dec 2011 05:00:00 +0100

Conclusions: While control of blood pressure remains a critical factor in the prevention of hypertensive nephropathy, Ang (1–7) may play a substantial role in preventing the structural changes in glomerulus through its effect on regulations of blood pressure and renal function. (Source: Therapeutic Advances in Cardiovascular Disease)

Feasibility, criterion validity and retest reliability of exercise testing using the Astrand-rhyming test protocol with an adaptive ergometer in stroke patients.

Disability and Rehabilitation — Thu, 08 Dec 2011 05:00:00 +0100

Conclusions: The Astrand-Rhyming test protocol and MOTOmed Viva2 adaptive ergometer were feasible in healthy participants. The protocol was not feasible for V·O(2max) estimation for the majority of stroke patients based on heart rate response. The adapted steady state VO2 measures used however were feasible and had strong relationship to actual VO2 consumption. Criterion validity and retest reliability of test data were excellent. [Box: see text]. PMID: 22148931 [PubMed - as supplied by publisher] (Source: Disability and Rehabilitation)

Factors Affecting the Aldosterone/Renin Ratio

Hormone and Metabolic Research — Tue, 06 Dec 2011 05:00:00 +0100

Horm Metab ResDOI: 10.1055/s-0031-1295460Although the aldosterone/renin ratio (ARR) is the most reliable screening test for primary aldosteronism, false positives and negatives occur. Dietary salt restriction, concomitant malignant or renovascular hypertension, pregnancy and treatment with diuretics (including spironolactone), dihydropyridine calcium blockers, angiotensin converting enzyme inhibitors, and angiotensin receptor antagonists can produce false negatives by stimulating renin. We recently reported selective serotonin reuptake inhibitors lower the ratio. Because potassium regulates aldosterone, uncorrected hypokalemia can lead to false negatives. Beta-blockers, alpha-methyldopa, clonidine, and nonsteroidal anti-inflammatory drugs suppress renin, raising the ARR with potential fo...

Temporal analysis of mRNA and miRNA expression in transgenic mice overexpressing Arg- and Gly389 polymorphic variants of the {beta}1-adrenergic receptor

Physiological Genomics — Mon, 05 Dec 2011 05:00:00 +0100

Several studies in humans or transgenic animals have reported that the 389 Arg or Gly polymorphic variation of the β1-adrenergic receptor (AR) is associated with differential responses to beta-blocker therapy and/or myocardial disease progression. Analysis of changes in gene expression is an important means of defining molecular differences associated with structural or functional phenotypic variations. To determine if structural and functional myocardial phenotypic differences between β1389 Arg vs. Gly transgenic overexpressors are associated with qualitative and/or quantitative differences in gene expression, a comprehensive analysis of mRNAs and miRNAs expressed in the hearts of 3 and 6–8 mo old β1-Arg389 and β1-Gly389 overexpressor transgenic mice was performe...

Effects of indomethacin and propranolol on Chironomus riparius and Physella (Costatella) acuta.

Ecotoxicology and Environmental Safety — Mon, 05 Dec 2011 05:00:00 +0100

Authors: López-Doval JC, Kukkonen JV, Rodrigo P, Muñoz I Abstract New analytical methods are available for detecting novel xenobiotic compounds in freshwater systems. Pharmaceuticals are suspected of having effects on freshwater biota at very low concentrations, although the nature of these effects remains unclear. Previous data from the Llobregat River revealed a positive statistical relationship between the biomass of benthic macroinvertebrates and the presence of certain non-steroidal anti-inflammatory drugs (NSAIDs) and beta-blockers. Here, experiments were conducted with the midge Chironomus riparius and the freshwater snail Physella (Costatella) acuta in sediments and water, respectively. The sediments and water were treated with the pharmaceuticals propranolol and indometh...

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The relationship between D-dimer level and the development of atrial fibrillation in patients with systolic heart failure

Journal of Thrombosis and Thrombolysis — Sat, 03 Dec 2011 16:48:57 +0100

Effect of beta blockade on natriuretic peptides and copeptin in elderly patients with heart failure and preserved or reduced ejection fraction: Results from the CIBIS-ELD trial.

Clinical Biochemistry — Fri, 02 Dec 2011 05:00:00 +0100

CONCLUSIONS: After 12weeks of BB optimization copeptin might reflect successful up-titration faster than NT-proBNP in HFREF, while the opposite was found in patients with HFPEF. PMID: 22155435 [PubMed - as supplied by publisher] (Source: Clinical Biochemistry)

Is target dose the treatment target? Uptitrating beta-blockers for heart failure in the elderly

International Journal of Cardiology — Fri, 02 Dec 2011 05:00:00 +0100

Abstract: Background: Guideline-recommended beta-blocker (BB) target doses for patients with chronic heart failure can often not be reached. This secondary analysis of the CIBIS-ELD trial was carried out to better understand reasons for not achieving target doses.Methods: Changes in heart rate (HR) and other parameters during a 12-week up-titration period in 302 BB naïve patients were evaluated in the subgroups achieving 12.5, 25, 50, and 100% of the target dose (groups 1, 2, 3, and 4, respectively).Results: Achieved doses predominantly depended on baseline HR (means 68, 74, 76, and 84bpm in groups 1–4, respectively, P (Source: International Journal of Cardiology)

Rethinking Cocaine-Associated Chest Pain and Acute Coronary Syndromes

Mayo Clinic Proceedings — Thu, 01 Dec 2011 05:00:00 +0100

Every year more than 500,000 patients present to the emergency department with cocaine-associated complications, most commonly chest pain. Many of these patients undergo extensive work-up and treatment. Much of the evidence regarding cocaine’s cardiovascular effects, as well as the current management of cocaine-associated chest pain and acute coronary syndromes, is anecdotally derived and based on studies written more than 2 decades ago that involved only a few patients. Newer studies have brought into question many of the commonly held theories and practices regarding the etiology, diagnosis, and treatment of this common clinical scenario. However, there continues to be a paucity of prospective, randomized trials addressing this topic as it relates to clinical outcomes. We searched ...

Admission heart rate as a predictor of mortality in patients with acute coronary syndromes.

Acute Cardiac Care — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: In a population with ACS, a higher admission HR is an independent predictor of short- and medium-term prognosis, which is also independent of left ventricular function. PMID: 22142200 [PubMed - in process] (Source: Acute Cardiac Care)

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Internet-based intervention improves beta blocker prescription in MI patients

MedWire News - Cardiology — Thu, 01 Dec 2011 00:00:00 +0100

An internet-delivered intervention improves the prescription of beta blockers in ambulatory post-myocardial infarction patients, an analysis finds. (Source: MedWire News - Cardiology)

Stress And Keeping An Eye On The Goal

Health News from Medical News Today — Tue, 29 Nov 2011 09:00:00 +0100

Beta blockers prevent the negative effects of stress Stressed people fall into habits and their behaviour is not goal-directed. That the neurotransmitter norepinephrine plays a decisive role here is now reported in the Journal of Neuroscience by scientists from Bochum led by Dr. Lars Schwabe (RUB Faculty of Psychology). If the effect of norepinephrine is stopped by beta blockers, the stress effect does not occur. "The results may be important for addictive behaviours, where stress is a key risk factor" said Schwabe. "They are characterised by ingrained routines and habits... (Source: Health News from Medical News Today)

Improving Care After Myocardial Infarction Using a 2-Year Internet-Delivered Intervention: The Department of Veterans Affairs Myocardial Infarction-Plus Cluster-Randomized Trial [Original Investigation]

Archives of Internal Medicine — Mon, 28 Nov 2011 05:00:00 +0100

Conclusion A longitudinal, Internet-delivered intervention improved only 1 of 7 clinical indicators of cardiovascular management in ambulatory post-MI patients. (Source: Archives of Internal Medicine)

Keeping One's Eyes On The Goal Despite Stress

Health News from Medical News Today — Fri, 25 Nov 2011 09:00:00 +0100

Stressed people fall into habits and their behaviour is not goal-directed. That the neurotransmitter norepinephrine plays a decisive role here is now reported in the Journal of Neuroscience by scientists from Bochum led by Dr. Lars Schwabe (RUB Faculty of Psychology). If the effect of norepinephrine is stopped by beta blockers, the stress effect does not occur. "The results may be important for addictive behaviours, where stress is a key risk factor" said Schwabe. "They are characterised by ingrained routines and habits... (Source: Health News from Medical News Today)

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Intrinsic biventricular dysfunction in Marfan syndrome

Heart — Thu, 24 Nov 2011 05:00:00 +0100

Conclusions Biventricular ejection fraction was impaired in patients with MFS, and the impairment was independent of aortic elasticity and β-blocker usage. There was also a strong correlation between LVEF and RVEF. Our findings suggest intrinsic myocardial dysfunction in patients with MFS. Clinical trial registration http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1423. Unique Identifier: NTR1423 (Source: Heart)

Keeping one's eyes on the goal -- despite stress

EurekAlert! - Social and Behavioral Science — Thu, 24 Nov 2011 05:00:00 +0100

(Ruhr-University Bochum) Stressed people fall into habits and their behavior is not goal-directed. That the neurotransmitter norepinephrine plays a decisive role here is now reported in the Journal of Neuroscience by scientists from Bochum led by Dr. Lars Schwabe. If the effect of norepinephrine is stopped by beta blockers, the stress effect does not occur. "The results may be important for addictive behaviors, where stress is a key risk factor," said Schwabe. (Source: EurekAlert! - Social and Behavioral Science)

Medication adherence for 90-day quantities of medication dispensed through retail and mail order pharmacies.

The American Journal of Managed Care — Tue, 22 Nov 2011 14:18:04 +0100

Conclusions: On a propensity-matched basis, patients who fill maintenance prescriptions at retail have a slightly, but statistically significantly, higher MPR than patients who fill their prescriptions by mail. PMID: 22084921 [PubMed - in process] (Source: The American Journal of Managed Care)

JAMA: 1 in 4 ICD patients don't receive optimal medical therapy

Cardiovascular Business News — Mon, 21 Nov 2011 13:14:02 +0100

The administration of optimal medical therapy (OMT) to patients with implantable cardioverter-defibrillators (ICDs) may decrease mortality; however, according to a research letter published online Nov. 14 in the Journal of the American Medical Association, nearly one in four of these patients are not prescribed beta-blockers or ACE inhibitors/ARBs. (Source: Cardiovascular Business News)

Differences Between Internists and Family Practitioners in the Diagnosis and Management of the Same Patient With Coronary Heart Disease

Medical Care Research and Review — Mon, 21 Nov 2011 05:00:00 +0100

This article explores differences between internists and family practitioners in their suggested diagnoses, level of diagnostic certainty, test and prescription ordering, when encountering exactly the same "patient" with coronary heart disease (CHD). Internists were more certain of a CHD diagnosis than family practitioners and were more likely to act on this diagnosis. Family practitioners were more likely to diagnose (and were more certain of) a mental health condition. While many physicians simultaneously entertain several alternate diagnoses, diagnostic certainty has shown to have an important influence on subsequent clinical actions, such as stress testing and prescription of beta blockers. These results may inform future educational strategies designed to reduce diagnostic uncertainty...

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Anti-hypertensive drugs as disease-modifying agents for Parkinson's disease: evidence from observational studies and clinical trials.

Cochrane Database of Systematic Reviews — Sun, 20 Nov 2011 22:06:03 +0100

CONCLUSIONS: There is currently a lack of evidence for the use of antihypertensive drugs for either the primary or secondary prevention of PD. More observational studies are required to identify potential drugs to go forward for safety and tolerability studies in people with early PD. The results of the ongoing trial will help inform further research. PMID: 22071852 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

What has changed in the treatment of ST-segment elevation myocardial infarction in Poland in 2003-2009? Data from the Polish Registry of Acute Coronary Syndromes (PL-ACS).

Kardiologia Polska — Sat, 19 Nov 2011 21:24:02 +0100

Conclusions: The PL-ACS Registry results demonstrate low short- and long-term mortality rates in STEMI patients, mainly due to frequent use of interventional strategy, satisfactory logistics and appropriate drug therapy used. As a consequence, hospitalisation time has shortened. However, there are several issues that need to be improved such as shortening of pre- -hospital delays and increasing the rate of invasive treatment in patients presenting with cardiogenic shock. Kardiol Pol 2011; 69, 11: 1109-1118. PMID: 22090216 [PubMed - in process] (Source: Kardiologia Polska)

HOOPS trial finds detailed patient-pharmacist chat helps optimize HF meds

theHeart.org — Thu, 17 Nov 2011 13:30:00 +0100

The randomized study didn't see an effect on hard clinical outcomes, but it's always good to get beta-blocker and ACE-inhibitor doses to target. (Source: theHeart.org)

Heart failure and non-ST-segment elevation myocardial infarction: A review for a widespread situation.

European Journal of Internal Medicine — Wed, 16 Nov 2011 18:02:00 +0100

In conclusion, heart failure during a NSTEMI is a common and meaningful situation which warrants careful management and further investigation to reach stronger evidence for clinical recommendations. PMID: 22075276 [PubMed - in process] (Source: European Journal of Internal Medicine)

Beta-blocker migraine prophylaxis affects the excitability of the visual cortex as revealed by transcranial magnetic stimulation

The Journal of Headache and Pain — Wed, 16 Nov 2011 18:00:38 +0100

The objective of this study is to assess effects of beta-blocker migraine prophylaxis on cortical excitability determined by transcranial magnetic stimulation (TMS). Phosphene and motor thresholds (PT, MT) were investigated in 29 patients with migraine, in 15 of them prior to and following preventive medication with metoprolol and in 14 patients without prophylaxis. Following prophylaxis headache frequency significantly decreased (p = 0.005) and mean PT were significantly increased (51.5 ± 7.5 vs. 63.6 ± 8.4%) compared to patients without preventive treatment (53.7 ± 5.3 vs. 52.3 ± 6.3%; p = 0.040). Mean MT did not significantly differ either between groups or due to treatment. In the group of all patients, a significant ...

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Alcohol Septal Ablation for the Treatment of Hypertrophic Obstructive Cardiomyopathy: A Multicenter North American Registry

Journal of the American College of Cardiology — Wed, 16 Nov 2011 17:36:37 +0100

Conclusions: Variables that predict mortality after ablation, include baseline ejection fraction and NYHA functional class, the number of septal arteries injected with ethanol, post-ablation septal thickness, beta-blocker use, and the number of ablation procedures. (Source: Journal of the American College of Cardiology)

Health Professional Shortage Areas, Insurance Status, and Cardiovascular Disease Prevention in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

Journal of Health Care for the Poor and Underserved — Wed, 16 Nov 2011 01:21:02 +0100

Authors: Brown TM, Parmar G, Durant RW, Halanych JH, Hovater M, Muntner P, Prineas RJ, Roth DL, Samdarshi TE, Safford MM Abstract Abstract:Individuals with cardiovascular disease (CVD) living in Health Professional Shortage Areas (HPSA) may receive less preventive care than others. The Reasons for Geographic And Racial Differences in Stroke Study (REGARDS) surveyed 30,239 African American (AA) and White individuals older than 45 years of age between 2003-2007. We compared medication use for CVD prevention by HPSA and insurance status, adjusting for sociodemographic factors, health behaviors, and health status. Individuals residing in partial HPSA counties were excluded. Mean age was 64±9 years, 42% were AA, 55% were women, and 93% had health insurance; 2,545 resi...

[Focus on beta-blockers for vascular specialists in 2012.]

Journal des Maladies Vasculaires — Tue, 15 Nov 2011 05:00:00 +0100

Authors: Mairesse S, Blacher J, Safar ME Abstract Since they were launched on the market in 1964, cardiovascular indications for beta-blockers have been validated and accepted worldwide. Numerous studies and meta-analysis have confirmed their benefits. They reduce mortality in post infarction and acute coronary syndrome populations and also in people with stable coronary heart disease. Moreover, heart failure with systolic left ventricular dysfunction is a major indication for this therapeutic class, providing a 30% decrease in mortality. In patients with permanent atrial fibrillation, beta-blockers are recommended for rate control. In hypertension patients, first-line drug treatment with beta-blockers is currently discussed. Indeed, several studies have shown that patients randomi...

Therapeutic perspectives in hypertension: novel means for renin-angiotensin-aldosterone system modulation and emerging device-based approaches

European Heart Journal — Mon, 14 Nov 2011 05:00:00 +0100

The conventional antihypertensive therapies including renin–angiotensin–aldosterone system antagonists (converting enzyme inhibitors, receptor blockers, renin inhibitors, and mineralocorticoid receptor blockers), diuretics, β-blockers, and calcium channel blockers are variably successful in achieving the challenging target blood pressure values in hypertensive patients. Difficult to treat hypertension is still a commonly observed problem world-wide. A number of drugs are considered to be used as novel therapies for hypertension. Renalase supplementation, vasopeptidase inhibitors, endothelin antagonists, and especially aldosterone antagonists (aldosterone synthase inhibitors and novel selective mineralocorticoid receptor blockers) are considered an option in resistant hyper...

Would a psychopath by any other name be as scary? | Martin Robbins

Guardian Unlimited Science — Wed, 09 Nov 2011 13:04:00 +0100

Jon Ronson's new book, The Psychopath Test, raises troubling questions about society's use of labels in tackling mental health issuesLabels are powerful things. Several years ago the anxiety and depression I've lived with all my adult life peaked, so I went to see my GP. "I feel really anxious and on edge," I told him. He handed me a questionnaire. I filled it in: Yes, I drink too much; No, I haven't tried to kill myself recently. "You're anxious," he told me, "take some of these beta-blockers. They'll help with your anxiety." Counselling wasn't available, but I didn't care - being able to pop a few pills seemed a lot more convenient than opening up my wounds for some stranger to inspect.Six months later I was even more anxious and depressed. The anti-anxiety pills hadn't had much effect, ...

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APHA: In CHF, Beta-Blockers Help Avoid Hospitalization

MedPage Today Public Health — Fri, 04 Nov 2011 18:27:33 +0100

WASHINGTON (MedPage Today) -- Medicare patients with congestive heart failure who adhere to beta-blocker therapy are more likely to avoid hospitalizations and to save the Medicare system money, according to data presented at the American Public Health Association meeting. (Source: MedPage Today Public Health)

Limited role for ivabradine in the treatment of chronic heart failure

Heart — Fri, 04 Nov 2011 04:00:00 +0100

Conclusions After uptitration of heart failure medications, the number of patients ‘suitable’ for ivabradine therapy was small. First and foremost, β-blocker therapy should be commenced and titrated. The decision to add ivabradine should be made after allowing adequate time to uptitrate conventional medical therapy. (Source: Heart)

Heart rate-associated mechanical stress impairs carotid but not cerebral artery compliance in dyslipidemic atherosclerotic mice

AJP: Heart and Circulatory Physiology — Thu, 03 Nov 2011 04:00:00 +0100

In conclusion, HR-dependent mechanical stress contributes to carotid artery wall stiffening in severely dyslipidemic mice while cerebrovascular compliance is mostly regulated by the endothelium. (Source: AJP: Heart and Circulatory Physiology)

Effects of preoperative oral beta blocker versus intraoperative nitroprusside or esmolol on quality of surgical field during tympanoplasty

Journal of Clinical Anesthesia — Tue, 01 Nov 2011 04:00:00 +0100

Conclusions: Although the three drugs are acceptable for obtaining an optimum surgical field, preoperative oral beta blocker appeared to be rapid in onset and was simpler to implement. (Source: Journal of Clinical Anesthesia)

Associations of plasma renin with 10-year cardiovascular mortality, sudden cardiac death, and death due to heart failure

European Heart Journal — Tue, 01 Nov 2011 04:00:00 +0100

Conclusions Plasma renin concentration is associated with long-term cardiovascular mortality in patients referred to coronary angiography. Further intervention studies should determine whether renin is a potential therapeutic target or only a marker of mortality risk in various cardiovascular risk groups. (Source: European Heart Journal)

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Intravenous esmolol infusion improves surgical fields during sevoflurane-anesthetized endoscopic sinus surgery: A double-blind, randomized, placebo-controlled trial.

American Journal of Rhinology and Allergy — Tue, 01 Nov 2011 04:00:00 +0100

CONCLUSION: Esmolol-induced relative hypotension and bradycardia during endoscopic sinus surgery achieves significantly improved SFs relative to saline control. PMID: 22185726 [PubMed - in process] (Source: American Journal of Rhinology and Allergy)

The feasibility of pharmacological mitigation of nitrogen narcosis during submarine escapes from depths down to 1,000 fsw.

Undersea and Hyperbaric Medicine — Tue, 01 Nov 2011 04:00:00 +0100

CONCLUSIONS: Prolongation of LBct could protect against N2 narcosis and it could plausibly be achieved with the oral administration of a beta-blocker, such as propranolol, prior to deep submarine escape. Animal experiments should be conducted to validate this pharmacological approach. PMID: 22292260 [PubMed - in process] (Source: Undersea and Hyperbaric Medicine)

The Month After: A Novel Tale on Eplerenone, But With a Different Ending⁎

Journal of the American College of Cardiology — Mon, 31 Oct 2011 00:58:28 +0100

The use of drugs counteracting activation of the renin-angiotensin-aldosterone system (RAAS), such as angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), and beta-blockers, reduces morbidity and mortality in heart failure (HF) (). However, ACEi/ARBs and beta-blockers do not uniformly suppress the RAAS. A long-term increase of aldosterone, a final product of the RAAS, has been observed in up to 40% of treated HF patients (aldosterone escape or breakthrough phenomenon) (). Aldosterone elevation, through RAAS activation, is also elicited by the frequent use of loop diuretics, which does not improve outcome in HF (). (Source: Journal of the American College of Cardiology)

Lipid Effects of Antihypertensive Medications

Current Atherosclerosis Reports — Sat, 29 Oct 2011 05:48:15 +0100

Abstract Thiazide diuretics and beta-blockers are first-line therapies for hypertension unless there are compelling indications for other drug classes. Diuretics and beta-blockers, however, may worsen dyslipidemia and glucose tolerance whereas antihypertensive agents in other drug classes may have neutral or beneficial effects. Initial clinical trials of antihypertensive regimens suggested that blood pressure lowering was the most important aspect of therapy and that the adverse effects on lipids and glucose tolerance did not impact clinical outcomes. Newer trials, however, question this finding and implicate these pleotropic effects as contributing to the results of the trials. Patients with cardiometabolic risk factors may have compelling indications for agents that inhi...

Topical prostaglandin fixed combinations in UK primary care: observational study using data from the health improvement network.

European Journal of Ophthalmology — Tue, 25 Oct 2011 04:00:00 +0100

Conclusions. The largest proportion of first-time recipients of prostaglandin/beta-blocker FC products treated in UK primary care was prescribed latanoprost/timolol FC. Twelve-month persistence was similar (<40%) across the 3 FCs evaluated. PMID: 22034021 [PubMed - as supplied by publisher] (Source: European Journal of Ophthalmology)

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[Mortality of myocardial infarction.]

Annales de Cardiologie et d'Angeiologie — Tue, 25 Oct 2011 04:00:00 +0100

Authors: Bonnefoy E, Kirkorian G Abstract Coronary disease is a major cause of death and disability. From 1975 to 2000, coronary mortality was reduced by half. Better treatments and reduction of risk factors are the main causes. This phenomenon is observed in most developed countries, but mortality from coronary heart disease continues to increase in developing countries. In-hospital mortality of ST elevation myocardial infarction (STEMI) is in the range of 7 to 10% in registries. In infarction without ST segment elevation (NSTEMI), in-hospital mortality is around 5%. More recent studies found a similar in-hospital mortality for STEMI and NSTEMI. Because of patient selection and monitoring, mortality in clinical trials is much lower. After adjustment for the extent of coronary dise...

Design and preliminary results of the Heart Function Assessment Registry Trial in Saudi Arabia (HEARTS) in patients with acute and chronic heart failure

European Journal of Heart Failure — Mon, 24 Oct 2011 04:00:00 +0100

Conclusion Heart failure patients in Saudi Arabia present at a relatively younger age, have a much higher rate of diabetes mellitus, and predominantly have LV systolic dysfunction, which is mainly ischaemic in origin, compared with patients in developed countries. The preliminary results of the study show potential targets for improvement in care. (Source: European Journal of Heart Failure)

Use of oral proton pump inhibitors is not associated with harm in patients with chronic heart failure in an ambulatory setting

European Journal of Heart Failure — Mon, 24 Oct 2011 04:00:00 +0100

Conclusion The use of PPIs in patients with HF is common. Despite in vitro concerns about negative inotropic effects with PPIs, there is no association with increased risk of mortality in chronic HF patients who use PPIs in an ambulatory setting. (Source: European Journal of Heart Failure)

Influence of renal dysfunction phenotype on mortality in the setting of cardiac dysfunction: analysis of three randomized controlled trials

European Journal of Heart Failure — Mon, 24 Oct 2011 04:00:00 +0100

Conclusion The association between RI and poor survival observed in heart failure populations appears to be contingent not simply on the presence of a reduced GFR, but possibly on the mechanism by which GFR is reduced. (Source: European Journal of Heart Failure)

Beta-Blockers Treatment May Reduce Melanoma Progression

Cancer Network — Sat, 22 Oct 2011 00:30:02 +0100

Researchers have shown that the use of β-adrenoceptor antagonists (β-blockers) for 1 year or more is associated with a decreased risk of progression of thick malignant melanoma. (Source: Cancer Network)

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Hypertension as a Risk Factor: Is It Different in Ischemic Stroke and Acute Myocardial Infarction Comparative Cross-Sectional Study?

EURASIP Journal on Bioinformatics and Systems Biology — Thu, 20 Oct 2011 11:29:32 +0100

Conclusion. Silent hypertension was high in Iraq. Salt-free diet noncompliance was high in both groups; drug noncompliance was significantly higher in patients with myocardial infarction. Angiotensin 11 receptor blocker use was associated significantly with myocardial infarction more than in stroke. (Source: EURASIP Journal on Bioinformatics and Systems Biology)

Ivabradine Versus Metoprolol for Heart Rate Reduction Before Coronary Computed Tomography Angiography

The American Journal of Cardiology — Thu, 20 Oct 2011 04:00:00 +0100

Several studies have demonstrated the correlation of heart rate (HR) and image quality in coronary computed tomography angiography. Beta-blocker administration is critical because of its negative inotropic effect. Ivabradine is a selective HR-lowering agent that exclusively inhibits the If current in sinoatrial node cells without having any effect on cardiac contractility or atrioventricular conduction. A total of 120 patients were randomized to oral premedication with ivabradine 15 mg or metoprolol 50 mg. HR and blood pressure (BP) were measured before the administration of premedication and immediately before coronary computed tomographic angiography. The mean time between premedication administration and follow-up was 108 ± 21.5 minutes for ivabradine and 110 ± 22.2 minutes for metopr...

Can all beta blockers improve the breast cancer survival?

The Breast — Mon, 17 Oct 2011 04:00:00 +0100

Recent studies have showed the importance of neuroendocrine regulation of breast cancer progression. Preclinical and epidemiological studies have designated that sympathetic nervous system and adrenergic neurotransmitters such as epinephrine and neuroepinephrine can regulate several pathways for tumor progression and metastasis. Emerging data suggest a dramatic new role for β-blockers in the treatment of breast cancer. However, there is limited data about the association of breast cancer and with a selective metoprolol usage. Thus, we aimed to investigate relationship between metoprolol usage and clinico-pathological properties of breast cancer. (Source: The Breast)

Endothelial Function is unaffected by changing between carvedilol and metoprolol in patients with heart failure - a randomized study

BioMed Central — Sat, 15 Oct 2011 04:00:00 +0100

Conclusion: Endothelial function remained unchanged when switching the beta blocker treatment from carvedilol to either metoprolol tartrate or metoprolol succinate in this study, where blood pressure and heart rate also remained unchanged in patients with mild HF.Trial registrationCurrent Controlled Trials NCT00497003 (Source: BioMed Central)

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Can all beta blockers improve the breast cancer survival?

Breast — Sat, 15 Oct 2011 04:00:00 +0100

Authors: Sendur MA, Aksoy S, Yaman S, Arik Z, Altundag K PMID: 22001140 [PubMed - as supplied by publisher] (Source: Breast)

Venlafaxine and atenolol disrupt epinephrine-stimulated glucose production in rainbow trout hepatocytes.

Aquatic Toxicology — Sat, 15 Oct 2011 04:00:00 +0100

Authors: Ings JS, George N, Peter MC, Servos MR, Vijayan MM Abstract The beta-blocker atenolol (ATEN), and the selective serotonin and norepinephrine reuptake inhibitor, venlafaxine (VEN) are found in municipal wastewater effluents, but little is known about the effect of these pharmaceuticals on aquatic animals. We tested the hypothesis that VEN and ATEN disrupt acute stress mediated glucose production in fish liver. To this end, rainbow trout (Oncorhynchus mykiss) hepatocytes were exposed in vitro to different concentrations (0, 0.1, 10, 1000nM) of VEN or ATEN and glucose production in response to either cortisol or epinephrine (two key stress hormones) was ascertained. Both VEN and ATEN did not affect either the unstimulated or cortisol (100ng/mL)-stimulated glucose release over...

Prophylactic left thoracic sympathectomy to prevent electrical storms in CPVT patients needing ICD placement

Heart, Lung and Circulation — Sat, 15 Oct 2011 01:44:50 +0100

We report simultaneous ICD insertion and thoracoscopic sympathectomy in a 10 year-old boy with CPVT, and suggest it as a better approach than sequential procedures. To our knowledge this is first such reported case. (Source: Heart, Lung and Circulation)

Changes in Myocardial Infarction Guideline Adherence as a Function of Patient Risk: An End to Paradoxical Care?

Journal of the American College of Cardiology — Sat, 15 Oct 2011 01:35:22 +0100

Conclusions: Although adherence to guideline-based care remains paradoxically lower in those MI patients at higher risk of mortality and most likely to benefit from treatment, care is improving for eligible patients within all risk categories, and the gaps between low- and high-risk groups seem to be narrowing. (Source: Journal of the American College of Cardiology)

Effects of selective heart rate reduction with ivabradine on left ventricular remodelling and function: results from the SHIFT echocardiography substudy

European Heart Journal — Fri, 14 Oct 2011 04:00:00 +0100

Conclusion Ivabradine reverses cardiac remodelling in patients with HF and LV systolic dysfunction. (Source: European Heart Journal)

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Bet 2: Intralipid/Lipid Emulsion in Beta-Blocker Overdose

Emergency Medicine Journal — Fri, 14 Oct 2011 04:00:00 +0100

A short cut review was performed to seek the evidence for use of intravenous lipid emulsion in the treatment of overdose with β-receptor antagonists. Eight case reports and one case series with a total of 10 patients were found. The authors, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses are tabulated. The clinical bottom line is that there is only anecdotal evidence of effectiveness for this treatment. (Source: Emergency Medicine Journal)

Prophylaxis and Management of Atrial Fibrillation After General Thoracic Surgery

Thoracic Surgery Clinics — Fri, 14 Oct 2011 04:00:00 +0100

Atrial fibrillation (AF) commonly affects patients after general thoracic surgery. Postoperative AF increases hospital stay and charges. Effective prophylaxis and treatment is the goal. Calcium channel blockers prevent postoperative AF. Beta blockers are a less viable choice. Amiodarone prophylaxis should be avoided in patients with pulmonary dysfunction or who require pneumonectomy. In management of AF, a brief trial of rate-control agents is appropriate; however, chemical cardioversion with rhythm-control agents should be instituted after 24 hours. High-risk patients with history of stroke or transient ischemic attack, or with two or more risk factors for thromboembolism should receive anticoagulation therapy. (Source: Thoracic Surgery Clinics)

Recurrence of heart failure symptoms after LVAD placement due to bradycardia-induced inflow obstruction

The Journal of Heart and Lung Transplantation — Fri, 14 Oct 2011 04:00:00 +0100

A 76-year-old man with a history of ischemic cardiomyopathy treated with a destination therapy left ventricular assist device (LVAD) presented with fatigue and dyspnea. The patient had undergone implantation of a HeartMate II (Thoratec Corp., Pleasanton, CA) LVAD 9 months prior to this presentation and was without any functional limitation until 8 weeks before evaluation. He described symptoms of progressive fatigue and exercise intolerance associated with pre-syncope. In addition, he noted frequent episodes of palpitations and light-headedness that were associated with spontaneous speed drops on the LVAD. These symptoms had persisted despite a reduction in the speed of the LVAD and discontinuation of beta-blocker therapy in response to bradycardia. (Source: The Journal of Heart and Lung T...

Don't {beta} blockers still have a role in hypertension?

BMJ Online First — Wed, 12 Oct 2011 04:00:00 +0100

The advice on the firstline treatment of younger and middle aged hypertensive patients with either an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker, with no mention of... (Source: BMJ Online First)

Drugs and pacemakers for vasovagal, carotid sinus and situational syncope.

Cochrane Database of Systematic Reviews — Tue, 11 Oct 2011 01:20:04 +0100

CONCLUSIONS: There is insufficient evidence to support the use of any of the pharmacological or pacemaker treatments for vasovagal syncope and carotid sinus syncope. Larger studies using patient relevant outcomes are needed. PMID: 21975744 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

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Evening versus morning dosing regimen drug therapy for hypertension.

Cochrane Database of Systematic Reviews — Tue, 11 Oct 2011 01:20:04 +0100

CONCLUSIONS: No RCT reported on clinically relevant outcome measures - all cause mortality, cardiovascular morbidity and morbidity. There were no significant differences in overall adverse events and withdrawals due to adverse events among the evening versus morning dosing regimens. In terms of BP lowering efficacy, for 24-hour SBP and DBP, the data suggests that better blood pressure control was achieved with bedtime dosing than morning administration of antihypertensive medication, the clinical significance of which is not known. PMID: 21975743 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Does heart drug boost cancer survival?

NHS News Feed — Mon, 10 Oct 2011 17:00:00 +0100

Conclusion This study suggests that there is an association between beta-blocker use and risk of death from any cause in patients diagnosed with malignant melanoma. The research has the advantage of being a large, population-based study that used data from several regularly updated databases. This aids in ensuring that the sample of patients studied was representative of the wider population, and that the information on drug use and cause of death was accurate. However, the study has several limitations that should be considered when interpreting the results. For example, the study was not controlled, and while the researchers attempted to adjust for likely or known confounding factors, there may be other unknown patient characteristics that account for the relationship. For example, hear...

Differing clinical courses and outcomes in two siblings with Barth syndrome and left ventricular noncompaction

European Journal of Pediatrics — Mon, 10 Oct 2011 15:06:39 +0100

Conclusion: The clinical courses of Barth syndrome observed in our cases show the phonotypic variability of this syndrome and suggest that early therapy may be beneficial for maintaining cardiac function. Content Type Journal ArticleCategory Original PaperPages 1-6DOI 10.1007/s00431-011-1597-0Authors Nobuo Momoi, Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295 JapanBo Chang, Department of Pediatrics, Toyama University, 2630 Sugitani, Toyama, 930-0194 JapanIzumi Takeda, Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295 JapanYoshimichi Aoyagi, Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295 JapanKisei E...

Trends in Glaucoma Medication Expenditure: Medical Expenditure Panel Survey 2001-2006 [Epidemiology]

Archives of Opthalmology — Mon, 10 Oct 2011 04:00:00 +0100

Conclusions Factors associated with increasing glaucoma medication expenditure trends include the increasing use of prostaglandin analogs, changes in insurance coverage, and possibly more aggressive glaucoma treatment. The findings are pertinent to the development of cost-effective strategies that optimize treatment and reduce expenditures. (Source: Archives of Opthalmology)

Do {beta}-Blockers Slow Down Melanoma Progression? [Editor's Correspondence]

Archives of Internal Medicine — Mon, 10 Oct 2011 04:00:00 +0100

(Source: Archives of Internal Medicine)

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Do {beta}-Blockers Slow Down Melanoma Progression?--Reply [Editor's Correspondence]

Archives of Internal Medicine — Mon, 10 Oct 2011 04:00:00 +0100

(Source: Archives of Internal Medicine)

Beta blockers help stop skin cancer spreading to other organs

the Mail online | Health — Mon, 10 Oct 2011 02:15:04 +0100

Beta blockers have been shown to reduce the death rate by 13 per cent by preventing tumours spreading to other organs. (Source: the Mail online | Health)

Home-based telemanagement in chronic heart failure: an 8-year single-site experience

Journal of Telemedicine and Telecare — Fri, 07 Oct 2011 04:00:00 +0100

During an eight-year period, 358 patients with chronic heart failure (CHF) were enrolled in a six-month home-based telemanagement (HBT) programme. The efficacy of the programme was evaluated in two four-year periods, based on changes in clinical, functional, Quality of Life (QoL) status and rate of hospital readmission. The New York Heart Association (NYHA) class and the number of patients with comorbidities increased significantly in the second period, while the number of patients with beta-blockers decreased significantly (P < 0.01). Following the HBT programme, non-cardiovascular hospital readmission rate and all-cause readmission rate increased by 11% (P < 0.03) and 13% (P < 0.05), respectively. On re-evaluation after six months (238 patients) there was a general improvement i...

Antihypertensive Shows Promise for AutismAntihypertensive Shows Promise for Autism

Medscape Today Headlines — Thu, 06 Oct 2011 15:27:48 +0100

The beta blocker propranolol is showing promise as a potential treatment for autism. Medscape Medical News (Source: Medscape Today Headlines)

Update on the Management of Acute Decompensated Heart Failure

Current Treatment Options in Cardiovascular Medicine — Thu, 06 Oct 2011 05:42:50 +0100

Opinion statement Treatment goals of acute decompensated heart failure are to decrease congestion, afterload, and neurohormonal activation in order to improve hemodynamics and symptoms and, perhaps, reduce in-hospital events, re-hospitalizations, and mortality while avoiding toxicities of therapy such as hypotension, arrhythmias, and renal dysfunction. Relief of congestion through intravenous loop diuretics is a mainstay of therapy. In cases where diuretics are not effective, ultrafiltration may be used to achieve euvolemia. Beta-blockers should be continued or reduced in dose at admission but should not typically be held. In patients with normotensive or hypertensive heart failure, afterload reduction with vasodilators should be instituted at presentation. Choice of a par...

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Beta-blockers could bring hope to breast cancer patients

Pharmaceutical Technology — Mon, 03 Oct 2011 17:46:17 +0100

Scientists in Europe are investigating whether blood pressure drugs, known as beta-blockers, could prevent the spread of breast cancer and improve survival.Post to:Delicious Digg reddit Facebook StumbleUpon (Source: Pharmaceutical Technology)

Beta-blockers 'may fight breast cancer'

Nursing Times Breaking News — Mon, 03 Oct 2011 11:15:00 +0100

Women with resistant breast cancer could benefit from the use of beta-blockers that are traditionally prescribed to help those with high blood pressure, new research has indicated. (Source: Nursing Times Breaking News)

Can Beta-Blockers Stop Spread Of Breast Cancer?

Health News from Medical News Today — Sun, 02 Oct 2011 18:00:00 +0100

During this month's breast cancer awareness campaign, an investigation conducted by UK cancer research scientists presented early results of whether beta-blockers control the spread of breast cancer and can improve survival to The Royal Society of Medicine. Beta-blockers are generally used for the treatment of high blood pressure (hypertension) and anxiety... (Source: Health News from Medical News Today)

Social Anxiety Disorder Treatment

Psych Central — Sat, 01 Oct 2011 13:40:37 +0100

Social Anxiety Disorder — also known as social phobia — is commonly treated by either psychotherapy or certain types of psychiatric medications. Social phobia is characterized by a persistent fear of social situations or performance situations (such as public speaking) where embarrassment might occur. While both psychotherapy and medications have been shown to be effective in the treatment of social anxiety disorder, a combination approach to treatment — utilizing both at the same time — may be the most timely and beneficial. While some people may find relief from some social anxiety symptoms through trying simple self-help techniques, most people with a diagnosed social phobia condition will need professional treatment in order to overcome it. Psychotherapy for ...

Half a Century of Hydrochlorothiazide: Facts, Fads, Fiction, and Follies

The American Journal of Medicine — Sat, 01 Oct 2011 04:00:00 +0100

Abstract: Hydrochlorothiazide (HCTZ) has become by far the most commonly prescribed antihypertensive drug in the US. In 2008, 47.8 million prescriptions were written for HCTZ alone and 87.1 million prescriptions for HCTZ combinations. However, there is no evidence that HCTZ in its usual dose of 12.5-25 mg daily reduces myocardial infarction, stroke, or death. In a meta-analysis of 19 randomized trials with over 1400 patients, the 24-hour decrease in blood pressure with HCTZ was inferior to angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and calcium channel blockers (P (Source: The American Journal of Medicine)

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[Comparative effects of nebivolol and valsartan on atrial electromechanical coupling in newly diagnosed stage 1 hypertensive patients].

Turk Kardiyoloji Dernegi arsivi — Sat, 01 Oct 2011 04:00:00 +0100

CONCLUSION: Prolonged interatrial electromechanical time intervals in hypertensives are improved with antihypertensive treatment. PMID: 21983766 [PubMed - in process] (Source: Turk Kardiyoloji Dernegi arsivi)

Team training can improve operating room performance

Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Conclusion: These data confirm that team training improves OR performance, but continued team training is required to provide sustained improved OR culture. (Source: Surgery)

Update on the medical treatment of stable angina.

Archives of Cardiovascular Diseases — Sat, 01 Oct 2011 04:00:00 +0100

Authors: Gayet JL, Paganelli F, Cohen-Solal A Abstract Stable angina is a form of coronary artery disease. Its potential to progress requires the most appropriate treatment in order to reduce the incapacitating effect of an acute angina attack and to avoid long-term cardiovascular events. With or without revascularization, pharmacological treatment is an essential component of this treatment strategy, which also involves lifestyle and diet. Statins and aspirin have been shown to be effective in preventing different aspects of coronary artery disease overall. The efficacy of other classes of treatment has been demonstrated in contexts such as stable angina (including postmyocardial infarction) and heart failure (under specific conditions of dosing) for beta-blockers and in contexts ...

Beta blockers 'may halt cancer'

BBC News | Health | UK Edition — Fri, 30 Sep 2011 23:04:39 +0100

Cancer experts are to carry out a major study to see if commonly used blood pressure drugs cut the risk of breast cancer spreading. (Source: BBC News | Health | UK Edition)

Blood pressure and anxiety tablets could provide lifeline for breast cancer sufferers

the Mail online | Health — Fri, 30 Sep 2011 06:58:39 +0100

Scientists say there is growing evidence to show that beta-blockers can stop breast cancer spreading and save lives. (Source: the Mail online | Health)

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Age and receipt of guideline-recommended medications for heart failure: a nationwide study of veterans

NeLM - Care of Older People — Fri, 30 Sep 2011 04:00:00 +0100

Source: Journal of General Internal Medicine Area: Evidence > Medicines Management > References Background: Older patients often receive less guideline-concordant care for heart failure than younger patients. Objective: To determine whether age differences in heart failure care are explained by patient, provider and health system characteristics and/or by chart-documented reasons for non-adherence to guidelines. Design and Patients: Retrospective cohort study of 2772 ambulatory veterans with heart failure and left ventricular ejection fraction less than 40% from a 2004 US nationwide medical record review programme (the US Veterans Administration External Peer Review Program). Main Measures: Ambulatory use of ACE inhibitors, angiotensin receptor blockers (ARBs) and beta blockers...

Reduction of oedema formation after preconditioning with dopamine in an isolated rat lung model is mediated by adrenergic receptors.

Annals of Transplantation — Fri, 30 Sep 2011 04:00:00 +0100

Conclusions: Our study suggests that dopamine mediated protective effects on I/R damage and inflammation in donor lungs are most likely mediated via adrenergic receptors. These findings are highly relevant because new strategies for organ preservation are necessary in terms of long donation waiting lists.<br /> PMID: 21959516 [PubMed - in process] (Source: Annals of Transplantation)

Is high-dose insulin better than vasopressors in treating toxin-induced cardiogenic shock?

The Poison Review — Fri, 30 Sep 2011 03:29:43 +0100

3 out of 5 stars High-dose insulin: A consecutive case series in toxin-induced cardiogenic shock. Holger JS et al. Clin Toxicol 2011;49:653-658. Abstract This observational case series, from Regions Hospital in St. Paul MN, retrospectively reviewed charts of patients seen by the toxicology service and treated for toxin-induced cardiogenic shock over an approximately 3 year period (February 2007 – March 2010). Cardiogenic shock was diagnosed if a patient exhibited signs or symptoms of organ hypoperfusion. Treatment of these patients was guided by a protocol that used high-dose insulin as the primary intervention and attempted to avoid vasopressors. The authors identified 12 cases. Cardiovascular toxins included: beta-blockers (BB, 5 patients) calcium-channel blockers (CCB, 2 ...

Beta-blockers as drug for breast cancer to be studied

Scotsman.com News - Health — Fri, 30 Sep 2011 00:00:00 +0100

Scientists in the UK are investigating whether beta-blockers could hold the key to preventing the spread of breast cancer and improving survival among women. (Source: Scotsman.com News - Health)

Traumatic Aortic Dissection in a Boy With Loeys-Dietz Syndrome [CASE REPORTS]

The Annals of Thoracic Surgery — Wed, 28 Sep 2011 04:00:00 +0100

A 9-year-old boy was admitted to the emergency department for interscapular chest discomfort. Bidimensional echocardiography revealed a severe aortic root and sino-tubular junction dilatation with a suspicion of intimal flap at the aortic isthmus and a pseudo-aneurysm which was confirmed by a computerized tomography scan. The patient was immediately transferred to the operating room for an emergent replacement of the aortic isthmus. His recovery after surgery was uneventful, and he was discharged home 12 days later on beta blockers and angiotensin II receptor antagonist. A genetic recognition confirmed the diagnosis of Loeys-Dietz syndrome type I. (Source: The Annals of Thoracic Surgery)

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Commonly used antihypertensives and lower urinary tract symptoms: results from the Boston Area Community Health (BACH) Survey

BJU International — Tue, 27 Sep 2011 04:00:00 +0100

CONCLUSION• Results are consistent with the hypothesis that certain AHTs may aggravate LUTS. The presence of new or worsening LUTS among AHT users suggests medications should be reviewed and a change in AHT class considered. (Source: BJU International)

Explaining structural change in cardiovascular mortality in Ireland 1995-2005: a time series analysis

The European Journal of Public Health — Mon, 26 Sep 2011 04:00:00 +0100

Conclusions: Cardiovascular prescribing accounts for the trend break in circulatory mortality among men and women aged ≥65 years after 1999 in Ireland but the effect of prescribing is lower for women. β-Blocker, ace inhibitor and aspirin medications were more successful than statin, diuretic and nitrates in accounting for the trends. (Source: The European Journal of Public Health)

Almanac 2011: heart failure. The national society journals present selected research that has driven recent advances in clinical cardiology

Heart — Fri, 23 Sep 2011 04:00:00 +0100

Provision of careNICE, audit and heart failure care The national heart failure audit1 in England and Wales continues to grow and provides vital data for planning heart failure services. The first formal report relates to over 6000 patients who were the first 10 patients admitted with a primary diagnosis of heart failure each month to one of 86 hospitals contributing data in 2008-09. Most had left ventricular systolic dysfunction, but an echocardiogram result was available in only 75%. In-patient mortality was 12% and in survivors, 80% were receiving an ACE inhibitor (or angiotensin receptor blocker (ARB)), 50% a β blocker and 30% an aldosterone antagonist at discharge. The audit for 21 000 patients hospitalised with heart failure in 2009–10 is also available.2 In-hospital mortal...

[Post-traumatic dysautonomic crises in intensive care unit: A French national assessment.]

Annales Francaises d'Anesthesie et de Reanimation — Fri, 23 Sep 2011 04:00:00 +0100

CONCLUSION: Although DC were a common complication in neuro-intensive care unit, their support seems mainly empirical. PMID: 21945703 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

Payment Source, Quality of Care, and Outcomes in Patients Hospitalized With Heart Failure

Journal of the American College of Cardiology — Wed, 21 Sep 2011 18:17:49 +0100

Conclusions: Decreased quality of care and outcomes for patients with HF were observed in the no-insurance, Medicaid, and Medicare groups compared with the private/health maintenance organization group. (Source: Journal of the American College of Cardiology)

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Blood Pressure Drugs May Lengthen Lives Of Melanoma Patients

Health News from Medical News Today — Wed, 21 Sep 2011 09:00:00 +0100

Beta-blocker drugs, commonly used to treat high blood pressure, may also play a major role in slowing the progression of certain serious cancers, based on a new study. A review of thousands of medical records in the Danish Cancer Registry showed that patients with the skin cancer melanoma, and who also were taking a specific beta-blocker, had much lower mortality rates than did patients not taking the drug... (Source: Health News from Medical News Today)

Beta-Blocker Dose Up-Titration or Addition of Ivabradine in Stable Angina: More is Not Necessarily Better

Cardiovascular Drugs and Therapy — Tue, 20 Sep 2011 05:47:40 +0100

Content Type Journal ArticleCategory EditorialPages 1-2DOI 10.1007/s10557-011-6340-6Authors Raymond W. Sy, Concord Clinical School, University of Sydney, Sydney, AustraliaSaul B. Freedman, Concord Clinical School, University of Sydney, Sydney, Australia Journal Cardiovascular Drugs and TherapyOnline ISSN 1573-7241Print ISSN 0920-3206 (Source: Cardiovascular Drugs and Therapy)

Blood pressure drugs may lengthen lives of melanoma patients

EurekAlert! - Medicine and Health — Tue, 20 Sep 2011 04:00:00 +0100

(Ohio State University) Beta-blocker drugs, commonly used to treat high blood pressure, may also play a major role in slowing the progression of certain serious cancers, based on a new study. A review of thousands of medical records in the Danish Cancer Registry showed that patients with the skin cancer melanoma, and who also were taking a specific beta-blocker, had much lower mortality rates than did patients not taking the drug. (Source: EurekAlert! - Medicine and Health)

Incidence and treatment of hypertension in the neonatal intensive care unit

Journal of the American Society of Hypertension — Mon, 19 Sep 2011 04:00:00 +0100

Abstract: The incidence and risk factors for hypertension in the neonatal intensive care unit (NICU) is inadequately defined, and the current utilization of antihypertensive medications in this specialized environment is not known. We evaluated the incidence of hypertension, associated risk factors, and utilization of antihypertensive drugs in the NICU using a large, geographically diverse pediatric database. A total of 123,847 NICU encounters were identified in the database. After exclusion of the 44,861 neonates with congenital cardiac disorders, 764 (1%) were coded with the diagnosis of hypertension. On multivariate analysis, the risk for hypertension was greatest in those neonates with a high All Patient Refined Diagnosis Related Groups (APR-DRG) severity of illness assessment (OR = 35...

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Cardiac medication prescribing and adherence after acute myocardial infarction in Chinese and South Asian Canadian patients

BioMed Central — Sun, 18 Sep 2011 04:00:00 +0100

Background: Failure to adhere to cardiac medications after acute myocardial infarction (AMI) is associated with increased mortality. Language barriers and preference for traditional medications may predispose certain ethnic groups at high risk for non-adherence. We compared prescribing and adherence to ACE-inhibitors (ACEI), beta-blockers (BB), and statins following AMI among elderly Chinese, South Asian, and Non-Asian patients. Methods: Retrospective-cohort study of elderly AMI survivors (1995-2002) using administrative data from British Columbia. AMI cases and ethnicity were identified using validated ICD-9/10 coding and surname algorithms, respectively. Medication adherence was assessed using the 'proportion of days covered' (PDC) metric with a PDC [greater than or equal to]0.80 indicat...

Pattern of use of beta-blockers in older patients with stable coronary artery disease: an observational, cross-sectional, multicentre survey

NeLM - Care of Older People — Fri, 16 Sep 2011 04:00:00 +0100

Source: Drugs and Aging Area: Evidence > Medicines Management > References Background: Several drugs, including beta-blockers (beta-adrenoceptor antagonists), are generally under-utilised in older patients with cardiovascular disease. Objectives: The aims of this study were to evaluate whether older patients (aged ?65 years) with coronary artery disease (CAD) have a different pattern of use of ?-blockers than younger adult patients (aged <65 years) and whether gender differences or other clinical variables may influence the use of these drugs. Methods: Over 6 months, 2226 outpatients with stable CAD were enrolled in an observational, cross-sectional, multicentre survey in Italy. Of these, 1416 patients aged 65 years or older were grouped into four subgroups according to ...

Resistant Hypertension: Concepts and Approach to Management

Current Hypertension Reports — Thu, 15 Sep 2011 15:46:14 +0100

Abstract Resistant hypertension (RH), defined simply, is blood pressure (BP) requiring the use of four or more antihypertensive agents, whether controlled or uncontrolled. RH is an increasingly common problem in elderly patients and may affect as many as 20% of the hypertensive population. Unfortunately, at least 30% of patients evaluated for RH are actually adequately controlled when more carefully assessed by home BP monitoring or ambulatory BP monitoring, thus representing a white coat effect. It is also essential to exclude pseudoresistance resulting from improper BP recording techniques or failure of the patient to adhere to the prescribed treatment regimen. Concurrent use of drugs that may interfere with prescribed antihypertensive agents, including many over the cou...

P1.17 A longitudinal analysis of cause-of-death in patients with Duchenne muscular dystrophy in Toneyama National Hospital

Neuromuscular Disorders — Tue, 13 Sep 2011 03:39:54 +0100

Mechanical ventilation and cardiac protective therapy have improved the prognosis and QOL of the patients with Duchenne muscular dystrophy (DMD). In order to how the introduction of these therapies changes prognosis, we made an analysis of cause-of-death in DMD patients from 1984, when we initiated mechanical ventilation for them. Mean age at death from 1984 to 1993 (1st term, n: 49) was 20.0±4.5, from 1994 to 2003 (2nd term, n: 48) was 25.2±4.6 and from 2004 to 2010 (3rd term, n: 47) was 31.1±5.4, respectively. Because mechanical ventilation was performed by tracheostomy in initial stage, some patients were reluctant to it and as a result respiratory failure occupied 43% of death in 1st term. Patients became acceptable for non-invasive ventilation and home mechanical ventilation (HMV) ...

MedWorm: Beta-Blockers

Effects of renin-angiotensin blockers/inhibitors and statins on mortality and functional impairment in polypathological patients.

Effects of Candesartan on Left Ventricular Function, Aldosterone and BNP in Chronic Heart Failure

Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction [PAPERS]

Pharmacist intervention in primary care to improve outcomes in patients with left ventricular systolic dysfunction

Guidelines for the diagnosis and management of Catecholaminergic Polymorphic Ventricular Tachycardia

Adherence with Migraine Prophylaxis in Clinical Practice

Laryngoscopy in conscious patients with remifentanil: how useful is an “awake look”?

The risk of elevated resting heart rate on the development of type 2 diabetes in patients with clinically manifest vascular diseases.

Patient Management After Noninvasive Cardiac Imaging: Results From SPARC (Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in Coronary Artery Disease)

Topical beta-blocker treatment for migraine

Pharmacological interventions in the treatment of the acute effects of Cannabis: a systematic review of literature

Postmenopausal Women with Constipation and Cardiovascular Disease

The Reply

Research suggests beta-blockers should be continued peri-operatively

{beta}-blockers associated with reduced all-cause mortality in COPD

Therapeutic approach for patients with catecholaminergic polymorphic ventricular tachycardia: state of the art and future developments

Trends in isolated coronary artery bypass grafting: An analysis of the Society of Thoracic Surgeons adult cardiac surgery database

Exanthematous drug eruption due to valsartan.

SMC does not recommend ranolazine (Ranexa®) as an add-on for stable angina

Effects of the long-term administration of nebivolol on the clinical symptoms, exercise capacity, and left ventricular function of patients with diastolic dysfunction: results of the ELANDD study

Glomerular Filtration Rate Estimated by the CKD-EPI Formula is a Powerful Predictor of In-Hospital Adverse Clinical Outcomes After an Acute Coronary Syndrome

{beta}-Blocker Continuation After Noncardiac Surgery: A Report From the Surgical Care and Outcomes Assessment Program [Original Article]

Preinjury Beta Blocker Usage does not Affect the Heart Rate Response to Initial Trauma Resuscitation

Does Selective Beta 1 Blockade Provide Bone Marrow Protection Following Trauma/Hemorrhagic Shock?

Beta Adrenergic Antagonists in Sepsis: Effects on Survival in A Murine Model

Aldosterone, mortality, and acute ischaemic events in coronary artery disease patients outside the setting of acute myocardial infarction or heart failure

Long‐term use of drugs affecting the renin‐angiotensin system and the risk of cancer. A population‐based case‐control study.

Case control study: Antihypertensive drugs and risk of incident gout among patients with hypertension

Ivabradine in combination with beta-blocker improves symptoms and quality of life in patients with stable angina pectoris: results from the ADDITIONS study

GRK2 Inhibition in Heart Failure: Something Old, Something New.

Serum Potassium Levels and Mortality in Acute Myocardial Infarction [Original Contribution]

Monocytes on the Scar's Edge⁎

The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting.

Managing hypertension among nursing-home residents and community-dwelling elderly in Germany: a comparative pharmacoepidemiological study

Pediatric Autonomic Testing: Retrospective Review of a Large Series

The Impact of COPD on Management and Outcomes of Patients Hospitalized with Acute Myocardial Infarction - A Ten-Year Retrospective Observational Study.

Unstable Angina and Non-ST Elevation Myocardial Infarction.

Intense Pulsed-Light Therapy for Proliferative Haemangiomas of Infancy

Interpretation of the Association between Beta-Blockers and Hip/Femur Fracture.

Interpretation of the Association between Beta-Blockers and Hip/Femur Fracture

Association between Perchlorate and Indirect Indicators of Thyroid Dysfunction in NHANES 2001-2002, a Cross-Sectional, Hypothesis-Generating Study.

Isolation, characterization, and in vitro propagation of infantile hemangioma stem cells and an in vivo mouse model

Acute myocardial infarction in a patient with hypofibrinogenemia: a case report

Republished editorial: Navigating adaptive challenges in quality improvement

Combined use of high-sensitivity ST2 and NTproBNP to improve the prediction of death in heart failure

Risk Stratification for Prevention of Sudden Cardiac Death

Betablockers induce cardiac chronotropic incompetence

European CHMP recommends approval of license extension for ivabradine (Procoralan) as treatment of chronic heart failure (NYHA II to IV) and updates contra-indications

Summary: International Kidney Cancer Symposium

Beta Blockers for Hypertensives Without Other Comorbidities: Going, Going. . . Gone?

Beta-blocker therapy is not associated with symptoms of depression and anxiety in patients receiving an implantable cardioverter-defibrillator

Attenuation of hypertension-mediated glomerulosclerosis in conjunction with increased angiotensin (1-7)

Feasibility, criterion validity and retest reliability of exercise testing using the Astrand-rhyming test protocol with an adaptive ergometer in stroke patients.

Factors Affecting the Aldosterone/Renin Ratio

Temporal analysis of mRNA and miRNA expression in transgenic mice overexpressing Arg- and Gly389 polymorphic variants of the {beta}1-adrenergic receptor

Effects of indomethacin and propranolol on Chironomus riparius and Physella (Costatella) acuta.

The relationship between D-dimer level and the development of atrial fibrillation in patients with systolic heart failure

Effect of beta blockade on natriuretic peptides and copeptin in elderly patients with heart failure and preserved or reduced ejection fraction: Results from the CIBIS-ELD trial.

Is target dose the treatment target? Uptitrating beta-blockers for heart failure in the elderly

Rethinking Cocaine-Associated Chest Pain and Acute Coronary Syndromes

Admission heart rate as a predictor of mortality in patients with acute coronary syndromes.

Internet-based intervention improves beta blocker prescription in MI patients

Stress And Keeping An Eye On The Goal

Improving Care After Myocardial Infarction Using a 2-Year Internet-Delivered Intervention: The Department of Veterans Affairs Myocardial Infarction-Plus Cluster-Randomized Trial [Original Investigation]

Keeping One's Eyes On The Goal Despite Stress

Intrinsic biventricular dysfunction in Marfan syndrome

Keeping one's eyes on the goal -- despite stress

Medication adherence for 90-day quantities of medication dispensed through retail and mail order pharmacies.

JAMA: 1 in 4 ICD patients don't receive optimal medical therapy

Differences Between Internists and Family Practitioners in the Diagnosis and Management of the Same Patient With Coronary Heart Disease

Anti-hypertensive drugs as disease-modifying agents for Parkinson's disease: evidence from observational studies and clinical trials.

What has changed in the treatment of ST-segment elevation myocardial infarction in Poland in 2003-2009? Data from the Polish Registry of Acute Coronary Syndromes (PL-ACS).

HOOPS trial finds detailed patient-pharmacist chat helps optimize HF meds

Heart failure and non-ST-segment elevation myocardial infarction: A review for a widespread situation.

Beta-blocker migraine prophylaxis affects the excitability of the visual cortex as revealed by transcranial magnetic stimulation

Alcohol Septal Ablation for the Treatment of Hypertrophic Obstructive Cardiomyopathy: A Multicenter North American Registry

Health Professional Shortage Areas, Insurance Status, and Cardiovascular Disease Prevention in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

[Focus on beta-blockers for vascular specialists in 2012.]

Therapeutic perspectives in hypertension: novel means for renin-angiotensin-aldosterone system modulation and emerging device-based approaches

Long‐term use of drugs affecting the renin‐angiotensin system and the risk of cancer. A population‐based case‐control study.