Beta-blocker Users Research Articles

Differential Cardiovascular Outcomes of Each Antihypertensive Drug Class in Patients With Hypertension and Breast Cancer Undergoing Doxorubicin-Containing Chemotherapy.

The preemptive use of renin-angiotensin system (RAS) inhibitors may reduce doxorubicin (DOX)-related cardiotoxicity. Using the national insurance claims data of Korea, this study compared cardiovascular (CV) outcomes following the use of four major antihypertensive drug classes in patients with hypertension and breast cancer who underwent DOX-containing chemotherapy. A total of 4,722 patients with hypertension and breast cancer who underwent DOX-containing chemotherapy were included. The outcomes were compared between patients who used RAS inhibitors, calcium channel blockers (CCBs), beta-blockers (BBs), and thiazide and thiazide-like diuretics (TDs). The primary outcome was a composite of incident heart failure and serious ventricular arrhythmias, including ventricular tachycardia and fibrillation, ischemic heart disease, and stroke. In the propensity score-matched population, there were no significant differences in the primary outcome between RAS inhibitor and CCB users; however, patients with diabetes who used CCBs had a worse primary outcome than those who used RAS inhibitors (adjusted hazard ratio [aHR], 1.93; 95% confidence interval [CI], 1.06-3.51). BB and TD users had a worse primary outcome compared with RAS inhibitor (aHR, 1.88; 95% CI, 1.30-2.71 in BB users and aHR, 2.55; 95% CI, 1.37-4.75 in TD users) or CCB (aHR, 1.54; 95% CI, 1.09-2.16 in BB users and aHR, 2.08; 95% CI, 1.13-3.82 in TD users) users. RAS inhibitors are preferred for the treating hypertension and improving CV outcomes in patients with hypertension and breast cancer undergoing DOX-containing chemotherapy, particularly in patients with comorbid diabetes. However, CCBs are equivalent to RAS inhibitors and are more favorable than BBs and TDs in terms of improving CV outcomes.

Effect of clinical progress in antihypertensive medications among COVID-19 patients

Objective: Many chronic diseases, such as hypertension, diabetes, and coronary heart disease, paving the way for the disease to progress unfavorably in Covid-19. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-2 receptor blockers (ARBs) can upregulate ACE2 receptors (which SARS-COV-2 uses to enter the host cell) or protect against infection by limiting the effects of Angiotensin 2. This study aimed to reveal the impact of antihypertensive drugs on the hospital staying, and mortality in Covid-19 patients followed in the hospital. Methods and Results: One hundred patients were randomly selected with hypertension, diabetes mellitus and coronary artery disease hospitalized in Kayseri City Training and Research Hospital due to Covid-19 infection. Patients were grouped as taking ACEIs and ARBs group and not taking ACEIs and ARBs group. There were no differences among the groups in terms of the frequency of chronic disease and treatment modalities. The length of the hospital stays, bedding into the Intensive Care Unit (ICU), and mortality rates were higher in the group without ACEIs or ARBs. Mortality was significantly lower among patients who used ACEIs and ARBs (P=0.00, P=0.02, respectively) and incredibly high among beta-blocker users (P=0.00). It was found that the advanced age, male gender and use of beta-blockers were associated with mortality. Conclusion: Although antihypertensive medications are allegedly associated with increased mortality rates, the risk of mortality has not been detected in people taking ACEIs and ARBs. Further studies involving a greater number of patients are needed.

Myocardial FDG uptake variation and its relationship with survival during immunotherapy.

e14604 Background: The rise of Immune Checkpoint Inhibitors (ICI) as a cancer treatment has been followed by the increase of cardiotoxicity events reports. Retrospective studies with anthracycline revealed a relationship between increased myocardial 18F-FDG uptake (MGU) and a slight drop in Left Ventricular Ejection Fraction (LVEF) values, suggesting that this may be a useful tool for early detection of cardiotoxicity. Our study is intended to evaluate the prognostic impact of the variation in MGU in advanced lung cancer undergoing treatment with ICI. Methods: This is a unicentric, retrospective study, that evaluated lung cancer patients treated with ICI from 2016 to 2020 and submitted to at least two positron emission tomography (PET-CT). The primary objective was to evaluate the MGU variation during ICI treatment (ΔSUV) and its impact on survival outcomes. Numerical variables are described using a median and interquartile range. Categorical variables are described using absolute and relative frequencies. Mann-Whitney test was applied to compare the median between groups. progression-free survival and overall survival were calculated using the Kaplan-Meier method and the Log Rank test was used to compare survival curves. Alpha level = 0.05. Results: 43 patients fulfilled all inclusion criteria. 51% received Immunotherapy plus chemotherapy and 49% received only immunotherapy. Global median ΔSUV was +0.14; among patients in the disease control group, the median ΔSUV was +0.3, while the median ΔSUV of the disease progression group was -0.47. Considering patients with positive myocardial ΔSUV versus negative ΔSUV, there was a median increase of progression-free survival (PFS) of 112 days in favour of the positive myocardial ΔSUV group (p = 0.087). The overall survival (OS) of patients that used beta-blockers(BB) was higher than those who did not, with an increase of 575 days on median OS (p = 0.159). The increase in the PFS median by 112 days on those patients who presented a positive ΔSUV may suggest that better treatment outcomes are related to the rise of myocardial SUV, although the sample size was not sufficient to reach statistical significance. Another important association, albeit not statistically significant, was the growth of PFS mean by 575 days with the usage of BB, such growth was not evidenced on the patients which used ACE inhibitors or ARBs; indicating that BB could have a supporting role on ICI treatment. Those findings correlate to recent evidence that shows an increase in MGU after BB usage and that BB may work as immune-modulating agents improving ICI therapies. Conclusions: The increase in MGU was associated with better outcomes, suggesting that it could be studied as a predictor of treatment response, in addition to the benefit also shown with the use of BB, which strengthens their possible synergistic effect in treatment. However, more robust studies are needed to better understand the MGU role on ICI treatment.

Treatment of Open-Angle Glaucoma and Ocular Hypertension with Preservative-Free Tafluprost/Timolol Fixed-Dose Combination Therapy: Results from the VISIONARY Study Population in Spain.

Purpose:Data are presented from ophthalmology clinics in Spain participating in the VISIONARY study, examining the effectiveness, tolerability, and safety of the preservative-free tafluprost (0.0015%) and timolol (0.5%) fixed-dose combination (PF tafluprost/timolol FC) in the treatment of OAG and OHT.Methods:An observational, multicenter prospective study examined treatment outcomes following a switch to PF tafluprost/timolol FC in adult OAG/OHT patients demonstrating insufficient response to beta-blocker or prostaglandin analog (PGA) monotherapy. Primary end point was mean change in intraocular pressure (IOP) from baseline at month 6. Changes in the severity of ocular signs and symptoms were also assessed.Results:Overall, 92 patients (51.1% female) were included. Mean (standard deviation) age was 68.3 (12.1) years. Mean IOP was reduced from 21.9 mmHg at baseline to 16.7 mmHg at month 6 (22.3% decrease; P < 0.0001). Significant IOP reductions were observed at weeks 4 and 12 (P < 0.0001). Baseline PGA and beta-blocker users demonstrated mean month 6 IOP reductions of 5.5 mmHg (23.5%; P < 0.001) and 3.5 mmHg (14.6%; P = 0.029), respectively. Severity of conjunctival hyperemia, dry eye, irritation, itching, foreign body sensation, and eye pain was significantly reduced. Three treatment-related adverse events were reported, all were nonserious and mild/moderate in severity.Conclusion:In real-world clinical practice, PF tafluprost/timolol FC treatment provided significant IOP reductions over 6 months and was well tolerated among OAG/OHT patients showing poor response to PGA or beta-blocker monotherapy. IOP-lowering efficacy and improvements in ocular signs and symptoms were evident from week 4 and maintained over the 6-month study period. Trial Registration: European Union electronic Register of Post-Authorisation Studies (EU PAS) register number EUPAS22204.

Beta-Blocker-Related Atrioventricular Conduction Disorders-A Single Tertiary Referral Center Experience.

Background and Objectives: Drug-related bradyarrhythmia is a well-documented major adverse event among beta-blocker users and a potential cause for hospitalization or additional interventions. Whether beta-blocker use is associated with specific bradyarrhythmia presentations, and how this relates to other predisposing factors, is not well known. We aim to evaluate the association between beta-blocker use and the type of atrioventricular (AV) conduction disorder in patients with symptomatic bradycardia. Materials and Methods: We conducted a retrospective cohort study on 596 patients with a primary diagnosis of symptomatic bradyarrhythmia admitted to a single tertiary referral center. Of the cases analyzed, 253 patients were on beta-blocker treatment at presentation and 343 had no bradycardic treatment. We analyzed demographics, clinical and paraclinical parameters in relation to the identified AV conduction disorder. A multivariate regression analysis was performed to explore factors associated with beta-blocker use. Results: Of the 596 patients (mean age 73.9 ± 8.8 years, 49.2% male), 261 (43.8%) had a third-degree AV block, 92 (15.4%) had a second-degree AV block, 128 (21.5%) had slow atrial fibrillation, 93 (15.6%) had sick sinus syndrome and 21 (3.5%) had sinus bradycardia/sinus pauses. Beta-blocker use was associated with the female gender (p < 0.001), emergency admission (p < 0.001), dilated cardiomyopathy (p = 0.003), the lower left ventricular ejection fraction (p = 0.02), mitral stenosis (p = 0.009), chronic kidney disease (p = 0.02), higher potassium levels (p = 0.04) and QRS duration > 120 ms (p = 0.02). Slow atrial fibrillation (OR = 4.2, p < 0.001), sick sinus syndrome (OR = 2.8, p = 0.001) and sinus bradycardia/pauses (OR = 32.9, p < 0.001) were more likely to be associated with beta-blocker use compared to the most common presentation (third-degree AV block), after adjusting for other patient characteristics. Conclusions: Beta-blocker use is more likely to be associated with slow atrial fibrillation, sick sinus syndrome and sinus bradycardia/pauses, compared to a second- or third-degree AV block, after adjusting for other patient factors such as gender, admission type, ECG, comorbidities, cardiac function and lab testing.

Use of beta-blockers and risk of contralateral breast cancer.

Beta-blockers have shown antineoplastic effects in laboratory studies but epidemiologic evidence in relation to contralateral breast cancer (CBC) is sparse. We investigated postdiagnosis beta-blocker use and risk of CBC in a cohort of 52 723 women with breast cancer by using nationwide Danish health registers and the Danish Breast Cancer Group database. We defined postdiagnosis beta-blocker use as a time-varying covariate starting 1 year after a second prescription was redeemed. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CBC associated with beta-blocker use compared to nonuse. We identified 1444 women with CBC of whom 209 women were beta-blocker users. We found an overall HR of 1.08 (95% CI: 0.93-1.27) for beta-blocker use and risk of CBC with no substantial variation according to cumulative amount, intensity or selectivity of beta-blocker use. Hence, our cohort study of women with breast cancer did not sustain a protective effect of beta-blocker use on risk of CBC, irrespective of beta-blocker type.

Dental students' attitude towards propranolol non-medical use: A multi-institutional cross-sectional study in Riyadh, Saudi Arabia.

The lives of college students are full of various stressors. Students seek a number of stress-relieving modalities as self-prescribed beta-blockers to improve their academic performance. The aim of this study was to assess the extent of beta-blockers (propranolol) usage amongst Saudi dental students and their attitude towards its use to enhance academic performance. A cross-sectional study involving a convenient sample was conducted on a group of undergraduate dental students enrolled in Riyadh dental schools during the academic year of 2019/2020. A paper format closed-ended questionnaire was used. A sample of 680students participated in the survey (43% response rate). Approximately 12% of dental students used propranolol for non-medical reasons. The prevalence did not differ significantly with the gender or year of study. A significantly higher percentage of students from private dental schools reported using propranolol for non-medical reasons (odds ratio (OR), 3.1; 95% confidence interval (CI), 1.7-5.4; p<.001). Propranolol users were significantly more likely to connect with other students using the medication. Both students, those who used and those who did not use propranolol, similarly, highly endorsed the need for being informed about the risk of using propranolol. Compared with non-users, there was more disagreement amongst propranolol users on the necessity for placing school regulations controlling medication use. The use of propranolol to enhance academic performance amongst dental students in Saudi Arabia should not be disregarded. The study findings emphasise the importance of regulating students' usage of beta-blockers to promote a fair academic environment.

Treatment of open angle glaucoma or ocular hypertension with preservative‐free tafluprost/timolol fixed dose combination in a real‐world setting: analysis by diagnostic sub‐group at study entry

AbstractPurposeThe VISIONARY study assessed the efficacy of the preservative‐free tafluprost/timolol fixed‐dose combination (PF tafluprost/timolol FC) in patients with open‐angle glaucoma (OAG) or ocular hypertension (OHT) who were inadequately controlled with prostaglandin analogue (PGA) or beta‐blocker (BB) monotherapy. This analysis examined IOP reduction by diagnosis and prior treatment type.MethodsIOP was recorded at baseline for adults (≥18 years) receiving topical PGA or BB monotherapy for OAG/OHT and treatment was switched to PF tafluprost/timolol FC. IOP was recorded at Weeks 4, 12 and 24. The primary endpoint was mean absolute change in IOP from baseline at Month 6. Baseline diagnoses were OHT (n = 110), primary open‐angle glaucoma (POAG; n = 425), normal tension glaucoma (NTG; n = 13), or pseudoexfoliative glaucoma (PEX; n = 19).ResultsMean (SD) baseline IOP was 21.5 (5.00) mmHg, 22.3 (4.30) mmHg, 17.2 (2.68) mmHg and 21.7 (4.13) mmHg for patients with POAG, OHT, NTG and PEX, respectively. Respective Month 6 relative IOP reductions were 25.4%, 26.1%, 15.8% and 17.6%. Mean (SD) baseline IOP was 21.9 (4.36) mmHg and 21.4 (4.48) mmHg for BB and PGA users, respectively. Month 6 respective IOP reduction from baseline was 6.6 (4.16) mmHg (28.5%) and 5.4 (4.04) mmHg (23.6%) (p &lt; 0.0001). PF tafluprost/timolol FC was generally well tolerated; 14 patients discontinued due to poor local tolerance or insufficient IOP control.ConclusionsIn this real‐world study, PF tafluprost/timolol FC was effective and well‐tolerated in patients previously uncontrolled on BB or PGA monotherapy, irrespective of initial diagnosis and type of previous topical medication. Patients with OHT, POAG, NTG and PEX showed IOP reductions at Week 4 that were maintained throughout the study period.BibliographyOddone F, et al. Treatment of Open‐Angle Glaucoma and Ocular Hypertension with Preservative‐Free Tafluprost/Timolol Fixed‐Dose Combination Therapy: The VISIONARY Study. Adv Ther.2020;37(4):1436–51.

Association Between Lipophilic Beta-Blockers and Depression in Diabetic Patients on Chronic Dialysis.

Depression is associated with lower quality of life and increased risk of mortality. The prevalence of depression in chronic dialysis patients, as well as in patients with diabetes, is more than 20%. It is debated whether use of beta-blockers increases the risk of depression. Therefore, we examined in chronic dialysis patients with and without diabetes, the association between beta-blockers and depressive symptoms. Data were collected from the DIVERS-I study, a multicentre prospective cohort among chronic dialysis patients in the Netherlands. Depressive symptoms were assessed with the Beck Depression Inventory (BDI-II). We defined depressive symptoms as a BDI-II score ⩾16. The cross-sectional association at baseline between depressive symptoms and beta-blocker use in chronic dialysis patients, was studied by multivariable logistic regression adjusted for potential confounders. We included 684 chronic dialysis patients, of whom 43% had diabetes mellitus, and 57% used a beta-blocker of which 97% were lipophilic. After multivariable adjustment, the OR (95% CI) for depressive symptoms in patients with compared to without diabetes was 1.41 (1.00-1.98), and in beta-blocker users compared to non-users 1.12 (0.80-1.56), respectively. Dialysis patients with diabetes and beta-blocker use compared to those without diabetes and not using beta-blockers had an OR of 1.73 (1.12-2.69) for depressive symptoms. The association was stronger in dialysis patients with diabetes and lipophilic beta-blocker use with an OR of 1.77 (1.14-2.74). We found a possible association between lipophilic beta-blocker use and depressive symptoms in chronic dialysis patients with diabetes.

Abstract 10201: Efficacy of Mavacamten in Patients with Symptomatic Hypertrophic Cardiomyopathy: Sub-Group Analyses by Background Beta-Blocker Use from the EXPLORER-HCM and MAVA-LTE Studies

Introduction: Mavacamten, a selective inhibitor of cardiac myosin, improved symptoms and exercise capacity (pVO 2 ) in adults with obstructive hypertrophic cardiomyopathy (oHCM) (EXPLORER-HCM; NCT03470545). Improvements in pVO 2 were observed regardless of whether patients were receiving beta-blockers (BB), but were greater in those not receiving BB. To examine whether BB lessen the effect of mavacamten on other parameters such as function, echocardiographic parameters, biomarkers and symptoms further sub-group analyses of EXPLORER-HCM and the mavacamten long-term extension (MAVA-LTE; NCT03723655) studies were conducted. Methods: In the phase 3, placebo-controlled EXPLORER-HCM trial, randomization was stratified by BB usage, and pre-specified sub-group analyses were performed. MAVA-LTE is an ongoing study evaluating long-term mavacamten dosing in patients with HCM who completed EXPLORER-HCM or MAVERICK. Sub-group analyses by BB usage for the same endpoints, if available, were performed post hoc including only patients with oHCM. Results: Results are shown in the Table. In EXPLORER-HCM, the majority of patients not taking BB received non-dihydropyridine calcium channel blockers (mavacamten [25/29 patients] or placebo [17/33]); this trend continued in MAVA-LTE. In EXPLORER-HCM, the mean change from baseline in pVO 2 was lower in the sub-group using BB (1.1 ml/kg/min) vs not using BB (2.2 ml/kg/min), while the heart rate-independent parameter, VE/VCO 2 slope (ventilatory efficiency), improved similarly in both groups (-2.4 vs -2.7). Improvements in symptoms (NYHA Class, KCCQ-CSS), LVOT gradients, LAVI, and biomarkers (NT-proBNP and cTnI) were similar between subgroups across both studies. Conclusion: In EXPLORER-HCM, the reduced effect of mavacamten on pVO2 in BB users is likely due to the effect of BB on heart rate response during exercise. Mavacamten benefits were observed across a range of clinically meaningful parameters regardless of BB use.

Antihypertensive Drug Use and the Risk of Depression: A Systematic Review and Network Meta-analysis.

Background: Although numerous cohort studies have reported an association between antihypertensives use and depression, the exact effect of antihypertensives on depression remains unclear. Objective: To clarify the association between antihypertensives use and risk of depression. Methods: We retrieved relevant literature using PubMed database until August 30, 2021. Four main classes of antihypertensives, thus, angiotensin antagonists, beta blockers, calcium channel blockers and diuretics were studied. The incidence of depression was pooled based on a single drug category. Network meta-analyses were conducted to comprehensively assess the effects of the four classes of antihypertensives on the risk of depression. Results: A total of nine out of 9,557 studies involving 414,873 subjects were retrieved. The pooled results showed a positive association between the use of calcium channel blockers and symptoms of depression [odds ratio (OR): 1.09, 95% confidence interval (CI):1.06–1.13], while use of the angiotensin antagonists, beta blockers and diuretics was not associated with risk of depression. Subgroup analysis suggested a significant relationship between beta blockers usage and risk of depression in cohort studies (OR:1.21, 95% CI: 1.16–1.26). The results of network meta-analysis indicated that all other three classes of drugs increased the risk of depression: angiotensin antagonists (OR: 1.30, 95% CI: 1.04–1.63), beta blockers (OR: 1.53, 95% CI: 1.22–1.91), and calcium channel blockers (OR: 1.40, 95% CI: 1.12–1.75), compared with diuretics. Conclusion: In conclusion, our results indicate that the use of angiotensin antagonists, beta blockers and calcium channel blockers are potential risk factors of depression.

Long-acting antimuscarinic therapy in patients with chronic obstructive pulmonary disease receiving beta-blockers

BackgroundBeta-blocker therapies for cardiovascular comorbidities are often withheld in patients with chronic obstructive pulmonary disease (COPD) due to potential adverse effects on airway obstruction. We carried out a post hoc analysis to determine the efficacy and safety of aclidinium in patients with moderate-to-very severe COPD and increased cardiovascular risk receiving beta-blockers at baseline versus non-users.MethodsASCENT-COPD was a Phase 4, multicenter, double-blind, randomized, placebo-controlled, parallel-group study. Patients were randomized 1:1 to aclidinium or placebo twice-daily for up to 3 years. Outcomes included risk of (time to first) major adverse cardiovascular events (MACE), all-cause mortality, and lung function over 3 years, and exacerbations over 1 year.ResultsOf 3589 patients, 1269 (35.4%) used beta-blockers and 2320 (64.6%) were non-users at baseline. Aclidinium did not statistically increase the risk of MACE (beta-blocker user: hazard ratio 1.01 [95% CI 0.62–1.64]; non-user: 0.80 [0.51–1.24]; interaction P = 0.48) or all-cause mortality (beta-blocker user: 1.13 [0.78–1.64]; non-user: 0.89 [0.62–1.26]; interaction P = 0.35), in patients using beta-blockers. Aclidinium reduced annualized rate of moderate-to-severe COPD exacerbation (beta-blocker user: rate ratio 0.75 [95% CI 0.60–0.94, P = 0.013]; non-user: 0.79 [0.67–0.93, P = 0.005]), delayed time to first exacerbation, and improved lung function versus placebo. There was greater trough FEV1 benefit in beta-blocker users versus non-users (least squares mean difference at 52 weeks: 111 mL [95% CI 74 mL–147 mL] versus 69 mL [42 mL–97 mL]; interaction P = 0.041).ConclusionsThis post hoc analysis supports long-acting anti-muscarinic use with concomitant beta-blockers in patients with moderate-to-very severe COPD and cardiovascular comorbidity.Trial registration: ClinicalTrials.gov, NCT01966107, Registered 16 October 2013, https://clinicaltrials.gov/ct2/show/NCT01966107.

Antipsychotics Use Is Associated With Greater Adherence to Cardiometabolic Medications in Patients With Schizophrenia: Results From a Nationwide, Within-subject Design Study.

People with schizophrenia/schizoaffective disorder (schizophrenia) die early, largely due to cardiovascular-related mortality. Antipsychotics are associated with lower mortality. We aimed to explore whether antipsychotic use can reduce discontinuation of medications for cardiovascular risk factors and diseases ("cardiometacolic drugs"), using a within-study design controlling for subject-related factors. Persons diagnosed with schizophrenia between 1972 and 2014, aged <65 years at cohort entry were identified in Finnish national databases. Four subcohorts were formed based on cardiometabolic drug use during the follow-up period, 1996-2017, namely statin (n = 14,047), antidiabetic (n = 13,070), antihypertensive (n = 17,227), and beta-blocker (n = 21,464) users. To control for subject-related factors, including likelihood of adherence as a trait characteristic, we conducted a within-subject study comparing the risk of discontinuation of each cardiometabolic drug during periods on vs off antipsychotics within each subject. We also accounted for number of psychiatric and nonpsychiatric visits in sensitivity analyses. In 52,607 subjects with schizophrenia, any antipsychotic use vs nonuse was associated with decreased discontinuation risk of antidiabetics (adjusted hazard ratio [aHR] = 0.56, 95% confidence interval [CI] = 0.47-0.66), statins (aHR = 0.61, 95%CI = 0.53-0.70), antihypertensives (aHR = 0.63, 95%CI = 0.56-0.71), and beta-blockers (aHR = 0.79, 95%CI = 0.73-0.87). Antipsychotics ranking best for discontinuation of all cardiometabolic drug categories were clozapine (aHR range = 0.34-0.55), followed by olanzapine (aHR = 0.43-0.71). For statins, aHRs ranged from aHR = 0.30 (95%CI = 0.09-0.98) (flupentixol-long-acting injectable (LAI) to aHR = 0.71 (95%CI = 0.52-0.97) (risperidone-LAI), for anti-diabetic medications from aHR = 0.37 (95%CI = 0.28-0.50) (clozapine) to aHR = 0.70 (95%CI = 0.53-0.92) (quetiapine), for antihypertensives from aHR = 0.14 (95%CI = 0.04-0.46) (paliperidone-LAI) to aHR = 0.69 (95%CI = 0.54-0.88) (perphenazine), for beta-blockers from aHR = 0.55 (95%CI = 0.48-0.63) (clozapine) to aHR = 0.76 (95%CI = 0.59-0.99) (perphenazine-LAI). The decreased risk of discontinuation associated with antipsychotic use somewhat varied between age strata. Sensitivity analyses confirmed main findings. In this national database within-subject design study, current antipsychotic use was associated with substantially decreased risk of discontinuation of statins, anti-diabetics, antihypertensives, and beta-blockers, which might explain reduced cardiovascular mortality observed with antipsychotics in people with schizophrenia.

Associations between beta-blocker use and psychological distress in bereaved adults with cardiovascular conditions.

The death of a close other is a major life stressor that disrupts mental and physical health. Beta-blocker medications are indicated treatments for cardiovascular conditions that may also mitigate psychological distress in the context of stressors by reducing adrenergic activity. We sought to examine observational links between beta-blocker medication use and psychological distress during bereavement. Using publicly available data from the Midlife in the United States Refresher study, we examined associations between beta-blocker use and general distress, depressive symptoms, and anxiety symptoms (as measured by the Mood and Anxiety Symptom Questionnaire) among bereaved adults with cardiovascular conditions (n=161) using t-tests and regression models. Beta-blocker users reported lower levels of anxiety-related general distress (b=-2.49, SE=0.88, p=0.005) and depression-related general distress than non-users (b=-2.39, SE=1.14, p=0.039) in multivariate linear regression models adjusting for demographic characteristics, mental health treatments, time since loss and comorbid health conditions. These observed links between beta-blockers and lower psychological distress in bereavement warrant further investigation in prospective and randomized studies, as beta-blockers could be a scalable intervention for mitigating distress following loss.

Current patterns of beta-blocker prescription in cardiac amyloidosis: an Italian nationwide survey.

AimsThe use of beta‐blocker therapy in cardiac amyloidosis (CA) is debated. We aimed at describing patterns of beta‐blocker prescription through a nationwide survey.Methods and resultsFrom 11 referral centres, we retrospectively collected data of CA patients with a first evaluation after 2016 (n = 642). Clinical characteristics at first and last evaluation were collected, with a focus on medical therapy. For patients in whom beta‐blocker therapy was started, stopped, or continued between first and last evaluation, the main reason for beta‐blocker management was requested. Median age of study population was 77 years; 81% were men. Arterial hypertension was found in 58% of patients, atrial fibrillation (AF) in 57%, and coronary artery disease in 16%. Left ventricular ejection fraction was preserved in 62% of cases, and 74% of patients had advanced diastolic dysfunction. Out of the 250 CA patients on beta‐blockers at last evaluation, 215 (33%) were already taking this therapy at first evaluation, while 35 (5%) were started it, in both cases primarily because of high‐rate AF. One‐hundred‐nineteen patients (19%) who were on beta‐blocker at first evaluation had this therapy withdrawn, mainly because of intolerance in the presence of heart failure with advanced diastolic dysfunction. The remaining 273 patients (43%) had never received beta‐blocker therapy. Beta‐blockers usage was similar between CA aetiologies. Patients taking vs. not taking beta‐blockers differed only for a greater prevalence of arterial hypertension, coronary artery disease, AF, and non‐restrictive filling pattern (P < 0.01 for all) in the former group.ConclusionsBeta‐blockers prescription is not infrequent in CA. Such therapy may be tolerated in the presence of co‐morbidities for which beta‐blockers are routinely used and in the absence of advanced diastolic dysfunction.

TREATMENT WITH BETA-BLOCKERS IS ASSOCIAT TREATMENT WITH BETA-BLOCKERS IS ASSOCIATED WITH AN INCREASED RISK FOR DEPRESSION AND ASTHENIA IN PATIENTS PRESENTING WITH COGNITIVE DISORDERS

Objective: Beta-blockers (BB) are among the most frequently prescribed medications worldwide. In the past, their potential to induce depression has been discussed controversially, and heterogeneous results have been published. We hypothesized that possible reasons for this heterogeneity may be differences in (1) the classification of patient-reported symptoms as “depression”, (2) the ability to pass the blood-brain-barrier for different BB, and (3) cerebral vulnerability of the exposed patients. In our study, we investigate the influence of BB use on two different cardinal symptoms of depression, depressive mood and asthenia. Furthermore, we examine whether the magnitude of these symptoms is moderated by the lipophilia of the BB and by the presence of dementia in Alzheimer's disease (DAT) as an indicator of cerebral damage. Design and Method: In this retrospective monocentric study we evaluated 196 patients aged 55 to 89 years who were admitted in our outpatient clinic for cognitive disorders. The sample included 98 users of BB, of whom 60 were diagnosed with DAT and 38 had subjective cognitive impairment (SCI) but inconspicuous results in neuropsychological testing and cerebral imaging. Furthermore, 13 patients had comorbid depression. A set of 98 non-users of BB was randomly matched to the BB users based on demographic parameters (gender, age, educational level) and psychiatric diagnoses. Depressive mood and asthenia were measured using subscores of the Geriatric Depression Scale (GDS). Design and method: We found a significant association between BB use and the GDS subscores for both asthenia and depressive mood, with higher values in BB users than in non-users (2.83 vs. 1.96; p &lt; 0.01 and 2.39 vs. 1.62; p &lt; 0.05). The risk was not affected by lipophilia status of BB (high vs. moderate) or cognitive diagnosis (DAT vs. SCI). Conclusion: The magnitude of both asthenia and depressive mood was distinctly higher in users of BB. Neither lipophilia of BB nor presence of DAT substantially influenced symptoms. In patients presenting with cognitive disorders on a BB medication, BB should be critically evaluated as possible etiology of asthenia and depressive mood.

Association of Antihypertensive Agents with the Risk of In-Hospital Death in Patients with Covid-19.

PurposeThe role of angiotensin receptor blockers (ARB), angiotensin-converting enzyme inhibitors (ACEi), or other antihypertensive agents in the case of Covid-19 remains controversial. We aimed to investigate the association between antihypertensive agent exposure and in-hospital mortality in patients with Covid-19.MethodsWe performed a retrospective multicenter cohort study on patients hospitalized between February 1 and May 15, 2020. All patients had been followed up for at least 30 days.ResultsOf the 8078 hospitalized patients for Covid-19, 3686 (45.6%) had hypertension and were included in the study. In this population, the median age was 75.4 (IQR, 21.5) years and 57.1% were male. Overall in-hospital 30-day mortality was 23.1%. The main antihypertensive pharmacological classes used were calcium channel blockers (CCB) (n=1624, 44.1%), beta-blockers (n=1389, 37.7%), ARB (n=1154, 31.3%), and ACEi (n=998, 27.1%). The risk of mortality was lower in CCB (aOR, 0.83 [0.70–0.99]) and beta-blockers (aOR, 0.80 [0.67–0.95]) users and non-significant in ARB (aOR, 0.88 [0.72–1.06]) and ACEi (aOR, 0.83 [0.68–1.02]) users, compared to non-users. These results remain consistent for patients receiving CCB, beta-blocker, or ARB as monotherapies.ConclusionThis large multicenter retrospective of Covid-19 patients with hypertension found a reduced mortality among CCB and beta-blockers users, suggesting a putative protective effect. Our findings did not show any association between the use of renin-angiotensin-aldosterone system inhibitors and the risk of in-hospital death. Although they need to be confirmed in further studies, these results support the continuation of antihypertensive agents in patients with Covid-19, in line with the current guidelines.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10557-021-07155-5.

A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery

PurposeDespite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery.MethodsThis is a retrospective nationwide observational cohort study. All adults ge 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality.Results134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26–0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure.ConclusionsBeta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.

Beta-blockers have no impact on survival in pancreatic ductal adenocarcinoma prior to cancer diagnosis

Previous studies have suggested that β-adrenergic signaling may regulate the growth of various cancers. The aim of our study is to investigate the association between the incidental use of beta-blockers for various conditions on the overall survival of patients with pancreatic ductal adenocarcinoma (PDAC). Patients with histologically-confirmed PDAC between 2007 and 2011 were extracted from Surveillance, Epidemiology, and End Results registry (SEER)-Medicare linked database. Kaplan Meier and multivariable Cox Proportional-Hazard models were used to examine the association between beta-blocker usage before diagnosis and overall survival adjusting for appropriate confounders. As an additional analysis we also examined continuous beta-blocker use before and after diagnosis. From 2007 to 2011, 13,731 patients were diagnosed with PDAC. Of these, 7130 patients had Medicare Part D coverage in the 6-month period before diagnosis, with 2564 (36%) of these patients using beta-blockers in this period. Patients receiving beta-blockers had a mean survival time of 5.1 months compared to 6 months for non-users (p < 0.01). In multivariable analysis, beta-blockers usage was not associated with improved survival (Hazard Ratio (HR) 1.04, 95%, Confidence Interval (CI) 0.98–1.1, p = 0.2). When patients were stratified by conditions with indications for beta-blocker usage, such as hypertension, coronary artery disease and cardiac arrhythmia, differences in survival were insignificant compared to non-users in all groups (p > 0.05). After stratification by receptor selectivity, this lack of association with survival persisted (p > 0.05 for all). As a subgroup analysis, looking at patients with continuous Medicare Part D coverage who used beta-blockers in the 6-month period before and after cancer diagnosis, we identified 7085 patients, of which 1750 (24.7%) had continuous beta blocker use. In multivariable analysis, continuous beta-blockers usage was associated with improved survival (Hazard Ratio (HR) 0.86, 95%, Confidence Interval (CI) 0.8–0.9, p < 0.01). Beta-blocker usage before diagnosis does not confer a survival advantage in patients with PDAC, though continuous use before and after diagnosis did confer a survival advantage. Prospective studies into the mechanism for this advantage are needed.

The Association between Beta-blocker Use and Chronic Obstructive Pulmonary Disease Risk, Severity, and Exacerbation

Background: There is controversy about the role of beta-blockers in the number of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). Objectives: The study aimed to find the role of beta-blockers using in the exacerbation number in patients with COPD in the presence of cardiovascular diseases (CVDs). Materials and Methods: In this comparative study, patients who attended the internal medicine department of two general hospitals in Erbil city and diagnosed with COPD with any CVD were included between April and November 2018. Results: The beta-blocker-using COPD patients were older compared to nonusing beta-blocker COPD patients (64.67 vs. 59.95 years, respectively) and had more comorbidities of myocardial infarction (28.1%) and heart failure (28.1%) (P &lt; 0.001). The study showed no significant difference in acute exacerbations (0.50 vs. 0.47; P= 0.821), forced expiratory volume 1 level (62.19 vs. 60.44; P= 0.544), between the user and nonuser beta-blockers, respectively. There was no significant difference in the number of acute exacerbations between COPD patients with CVD and without comorbidity in beta-blocker users; 0.45 versus 0.50; P= 0.820. While in nonusers of beta-blockers, the COPD patients with CVD had a significantly higher number of exacerbations (1.29) compared to those COPD patients without comorbidity (0.45; P= 0.020). The COPD beta-blocker using patients with CVD had significantly less number of exacerbation compared to those COPD nonusing beta-blocker patients with CVD. Conclusions: The present study showed that COPD patients who used beta-blockers have a substantially lower number of acute exacerbations in the last year compared to those COPD patients who did not use beta-blockers.