Selective Β1-blocker Research Articles

Beta-blocker use and fall risk in older individuals: Original results from two studies with meta-analysis.

To investigate the association between use of β-blockers and β-blocker characteristics - selectivity, lipid solubility, intrinsic sympathetic activity (ISA) and CYP2D6 enzyme metabolism - and fall risk. Data from two prospective studies were used, including community-dwelling individuals, n=7662 (the Rotterdam Study) and 2407 (B-PROOF), all aged ≥55years. Fall incidents were recorded prospectively. Time-varying β-blocker use was determined using pharmacy dispensing records. Cox proportional hazard models adjusted for age and sex were applied to determine the association between β-blocker use, their characteristics - selectivity, lipid solubility, ISA and CYP2D6 enzyme metabolism - and fall risk. The results of the studies were combined using meta-analyses. In total 2917 participants encountered a fall during a total follow-up time of 89 529years. Meta-analysis indicated no association between use of any β-blocker, compared to nonuse, and fall risk, hazard ratio (HR)=0.97 [95% confidence interval (CI) 0.88-1.06]. Use of a selective β-blocker was also not associated with fall risk, HR=0.92 (95%CI 0.83-1.01). Use of a nonselective β-blocker was associated with an increased fall risk, HR=1.22 (95%CI 1.01-1.48). Other β-blocker characteristics including lipid solubility and CYP2D6 enzyme metabolism were not associated with fall risk. Our study suggests that use of a nonselective β-blocker, contrary to selective β-blockers, is associated with an increased fall risk in an older population. In clinical practice, β-blockers have been shown effective for a variety of cardiovascular indications. However, fall risk should be considered when prescribing a β-blocker in this age group, and the pros and cons for β-blocker classes should be taken into consideration.

Cardiovascular medication and intraocular pressure: results from the Gutenberg Health Study

BackgroundIntraocular pressure (IOP) is well known to be associated with blood pressure and other cardiovascular risk factors. The influence of systemic cardiovascular, in particular antihypertensive, medication on IOP is still...

494 - Effects of low doses of esmolol on cardiac and vascular function in experimental septic shock

Administration of a selective β1-blocker, such as esmolol, in human septic shock has demonstrated cardiovascular protective effects related to heart rate reduction. Certain experimental data also indicate that esmolol exerts systemic anti-inflammatory and beneficial effects on vascular tone. Thus, the present study aimed to determine whether a non-chronotropic dose of esmolol maintains its protective cardiovascular and anti-inflammatory effects in experimental septic shock. Four hours after cecal ligation and puncture (CLP), Wistar male rats were randomly allocated to the following groups (n = 8): CLP, CLP + E-1 (esmolol: 1 mg.kg−1.h−1), CLP + E-5 (esmolol: 5 mg.kg−1.h−1), CLP + E-18 (esmolol: 18 mg.kg−1.h−1). An additional eight rats underwent sham operation. All rats received a continuous infusion of saline, analgesic and antibiotics 4 hours after the surgery. Assessment at 18 hours included in vivo cardiac function assessed by echocardiography and ex vivo vasoreactivity assessed by myography. Circulating cytokine levels (IL-6 and IL-10) were measured by ELISA. Cardiac and vascular protein expressions of p-NF-κB, IκBα, iNOS, p-AKT/AKT and p-eNOS/eNOS were assessed by western blotting. CLP induced tachycardia, hypotension, cardiac output reduction, hyperlactatemia and vascular hypo-responsiveness to vasopressors. Compared to CLP animals, heart rate was unchanged in CLP + E-1 and CLP + E-5 but was reduced in CLP + E-18. Stroke volume, cardiac output, mean arterial pressure and lactatemia were improved in CLP + E-1 and CLP + E-5, while vascular responsiveness to phenylephrine was only improved in CLP + E-5 and CLP + E-18. Plasma IL-6 levels were decreased in all esmolol groups. p-NF-κB was decreased in both cardiac and vascular tissues in CLP + E-5 and CLP + E-18. In experimental septic shock, low doses of esmolol still improved cardiac function and vasoreactivity. These benefits appear to be associated with a modulation of inflammatory pathways.

Assessment of a novel transdermal selective β1-blocker, the bisoprolol patch, for treating frequent premature ventricular contractions in patients without structural heart disease

BackgroundThe autonomic nervous system involves the genesis of premature ventricular contractions (PVCs). Previous studies demonstrated that heart rate (HR) dependency of idiopathic PVCs has different autonomic mechanisms. Recently, the bisoprolol patch, a novel transdermal β1-blocker formulation containing bisoprolol, became clinically available. We examined the efficacy of the bisoprolol patch for treating frequent PVCs in patients without structural heart disease (SHD) regarding the HR dependency of PVCs. MethodsThis prospective study included 44 consecutive patients without SHD (25 men, mean age, 63.6±12.3 years) with PVC counts≥3000 beats as measured by 24-hour Holter electrocardiograms (ECGs). PVCs were divided into positive HR-dependent PVCs (P-PVCs) and non-positive HR-dependent PVCs (NP-PVCs) based on the relationship between the hourly PVC density and hourly mean HR. A bisoprolol patch was administered once daily at a dose of 4mg. The 24-hour Holter ECGs were performed before and 1 month after the initiation of the therapy. ResultsIn 44 patients, there were 24 P-PVCs and 20 NP-PVCs. The bisoprolol patch reduced the PVC count significantly (from 16,563±10,056 to 7892±8817 beats/24hours, p<0.001) in the P-PVC group, while the PVC count did not change significantly (from 16,409±9571 to 13,476±12,191beats/24hours, p=0.34) in the NP-PVC group. Moreover, in the P-PVC group, the patients with mean HRs ≥80 beats/minute had a significantly higher percent improvement in the PVC count than those with mean HRs <80 beats/minute (p=0.0080). The bisoprolol patch resulted in a significant reduction in the PVC count from baseline during each time period for the changes within a 24-hour period in the P-PVC group. ConclusionsThe transdermal bisoprolol patch was effective for a PVC reduction in patients with P-PVCs, particularly in those with faster mean HRs. Furthermore, it demonstrated a stable PVC-reducing effect during the 24-hour period in the P-PVC group.

Increased infections with β-blocker use in ischemic stroke, a β2-receptor mediated process?

Strokes promote immunosuppression, partially from increased sympathetic activity. Altering sympathetic drive with β-blockers has variably been shown to improve stroke outcomes. This study adds to this literature using propensity score matching to limit confounding and by examining the effects of selective and non-selective β-blockers. Prospective data from acute ischemic stroke admissions at a single center from July 2010-June 2015 were analyzed. Outcomes included infection (urinary tract infection [UTI], pneumonia, or bacteremia), discharge modified Rankin Score (mRS), and in-hospital death. Any selective and non-selective β-blocker use during the first 3days of admission were investigated with propensity score matching. A sensitivity analysis was also performed. This study included 1431 admissions. Any β-blocker use was associated with increased infections (16.4 vs. 10.7%, p=0.030). Non-selective β-blocker use was associated with increased infections (18.9 vs. 9.7%, p=0.005) and UTIs (13.0 vs. 5.5%, p=0.009). Selective β-blocker use was not associated with infection. There were no associations between β-blocker use and in-hospital death or discharge mRS. In the sensitivity analysis, the association between non-selective β-blocker use and urinary tract infections persisted (12.5 vs. 4.2%, p=0.044). No associations with death or mRS were found. Early β-blocker use after ischemic stroke may increase the risk ofinfection but did not change disability or mortality risk. The mechanism may be mediated by β2-adrenergic receptor antagonism given the different effects seen with selective versus non-selective β-blocker use.

Impact of Combination Glaucoma Therapies on β-Blocker Exposure.

β-adrenergic receptor antagonists (β-blockers) used in the treatment of glaucoma are an often-overlooked source of systemic adverse events. Ophthalmic timolol has been associated with severe systemic adverse events including numerous cases resulting in death. In recent years the number of fixed-dose combination therapies for glaucoma has grown rapidly, and among available combination therapies only the nonselective β-blocker timolol is used as the β-blocker component. A population-based study was conducted in Ontario, Canada between January 1, 2001 and December 31, 2012 to assess the shift to combination therapies in the management of glaucoma, and to investigate the impact of this shift on the relative use of selective and nonselective β-blockers in patients with this disease. Between 2001 and 2012 timolol (nonselective β-blocker) use grew at an average annual rate of 2.2% (P<0.0001), whereas betaxolol (selective β-blocker) use declined by 14.1% per year (P<0.0001). These changes in the relative use of betaxolol and timolol coincided with changes in the relative use of combination and single-drug therapies. Over the study period, the use of β-blockers as single-drug therapy decreased by 7.7% annually (P<0.0001). In contrast, the use of combination therapies containing a β-blocker increased by 7.6% annually (P<0.0001). The introduction of fixed combination glaucoma therapies has been associated with a significant shift to greater use of nonselective β-blockers. In vulnerable older populations, this may have an important impact on patient safety that warrants further study.

Do we need an individual approach to atrial fibrillation and adrenergic overload in the critically ill?

Despite catecholamines being lifesaving drugs, they can also be harmful. Adrener-gic overload is one of the major causes of supra- and ventricular arrhythmias, which induce haemodynamic instability of criti-cally ill patients. In this paper we will focus on the pathophysiology of atrial fibrillation (AF), the importance of adrenergic over-load for triggering AF, the importance of the autonomic nervous system and we will challenge the importance of decreasing adrenergic load with selective and non-selective β-blockers, which have different effects on the metabolism of the severely ill.&nbsp;We will also emphasize the importance of an individual approach due to pharma-cogenetic differences in β-adrenergic sig-nalling.&nbsp;&nbsp

Kinetic resolution of (RS)-1-chloro-3-(4-(2-methoxyethyl)phenoxy)propan-2-ol: a metoprolol intermediate and its validation through homology model of Pseudomonas fluorescens lipase

Kinetic resolution of (±)-1-chloro-3-(4-(2-methoxyethyl)phenoxy)propan-2-ol: a metoprolol intermediate and its validation through homology model ofPseudomonas fluorescenslipase.

Prospective randomized study of the effect of nebivolol on the incidence of late invasive mechanical ventilation in ischemic heart disease patients with acute exacerbation of chronic obstructive pulmonary disease

Background Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the USA and acute exacerbations result in more than 800 000 hospitalizations annually. The combination of COPD treatment often coexists with treatment for congestive heart failure or ischemic heart disease (IHD) and present complex therapeutic challenges. β2-Agonists, which are frequently used in the treatment of COPD, have the potential for adverse cardiovascular effects including ischemic events and arrhythmias. β-Blocker therapy improves symptoms and survival among patients with IHD and congestive heart failure, but is frequently withheld in patients with COPD. During an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), patients may be particularly vulnerable to develop acute cardiac events due to increased use in β2-agonists, tachycardia, and hypoxemia. The addition of a cardioselective β-blocker, especially nebivolol, may have a cardioprotective effect in this population, blunting the cardiac toxicity of the β2-agonists. We evaluated the association of the cardioselective β-blocker nebivolol treatment with the incidence of late invasive ventilation among patients with IHD who were hospitalized for an AECOPD. Hypothesizing that the nebivolol as a highly selective β-blocker is not deleterious and is safe in the setting of AECOPD, we also compared the outcomes with patients who are not treated with nebivolol in the setting of AECOPD. Objective The aim of the paper was to study the incidence of late invasive mechanical ventilation among a group of ischemic heart disease patients with AECOPD who received oral nebivolol and compare the results with another group of patients with the same diagnosis who did not receive it. Patients and methods This study was conducted on 90 adult patients of both sexes, who were admitted to the Critical Care Medicine Department of Alexandria Main University Hospital after fulfilling the inclusion and exclusion criteria and obtaining an informed consent from patients’ relatives, and from the local ethics committee. Patients were subjected to full routine examination and categorized into two groups; each group comprised 45 patients using the sealed-envelop technique as a method for randomization of participants in both groups. Group I, patients who received oral nebivolol tablets on the first and/or second day of admission. Group II, patients who did not receive oral nebivolol tablets on the first and/or second day of admission. Results In comparing the patients in both groups, there was no statistically significant difference between them with regard to age, sex, comorbidities, and Acute Physiology and Chronic Health Evaluation II score on admission. Incidence of late invasive ventilation was the same between the case and the control groups. There was no significant difference in causes of intubation between both groups. There was no statistically significant reduction in the duration of invasive ventilation, ICU and hospital stay between both studied groups. Acute ischemic events showed no statistically significant reduction between case and control groups. Regarding in-hospital and 28-day mortality, there was no statistically significant difference between both studied groups. Conclusion Our results suggest that among the studied population of patients with AECOPD with underlying coronary artery disease, using oral nebivolol tablet seems to be safe as it does not cause worsening of the clinical condition of the patients regarding the incidence of late invasive mechanical ventilation or incidence of acute ischemic events. In addition, it does not affect the duration of ICU or hospital stay and showed no effect on in hospital or 28-day mortality.

Hazard screening of photo-transformation products from pharmaceuticals: Application to selective β1-blockers atenolol and metoprolol.

The identification of toxic components in cocktail mixtures of pollutants, their metabolites and transformation products (TPs) generated from environmental and treatment processes remains an arduous task. This study expanded in this area by applying a combination of chemical analytics, a battery of in vitro bioassays and an in silico "testing battery" to UV photolysis mixtures of active pharmaceutical ingredients. The objectives were to understand the toxic nature of the mixtures and to prioritize photo-TPs for risk analysis. The selective β1-blockers Atenolol (ATL) and Metoprolol (MTL) that are ubiquitous in the aquatic environment were used as an example. The photolysis mixtures were cytotoxic to Vibrio fischeri and mammalian cells but not mutagenic in the Ames test or genotoxic in the in vitro micronucleus and umu tests. Potentially hazardous TPs were proposed by relating the observed effects to the kinetics of TP occurrence and applying in silico toxicity predictions for individual photo-TPs. This model study was done to identify principal mechanisms rather than accurately simulating environmental transformation processes. Several photo-TPs were proposed to present a greater hazard than the selected β-blockers and therefore fate and toxicity assessments may be required to determine their environmental relevance.

Nebivolol Hydrochloride Loaded Nanostructured Lipid Carriers as Transdermal Delivery System: Part 1: Preparation, Characterization and In Vitro Evaluation

Nebivolol hydrochloride (NEB) is a 3rd generation highly selective β1-blocker with antihypertensive properties, the elimination half-life is about 10 hrs and the oral bioavailability is about 12%.&#x0D; The study was aimed to develop nanostructured lipid carriers (NLC) for transdermal delivery of NEB.&#x0D; The study involves two separate parts, part 1 (current) involves preparation and characterization of NEB loaded NLCs (NEB-NLCs). Part 2 of the study, NEB-NLCs based gel was formulated using gelling agent carbapol 934 as transdermal delivery system using rat skin. Part 2 of the study will be presented separately in the forthcoming issue.&#x0D; The current investigation describes the effect of type and concentration of different solid lipids, liquid lipids, and surfactant/co-surfactant on the characteristics of NLC such as particle size, polydispersity index, zeta potential, drug entrapment efficiency, and drug release profile. Transmission electron microscopy, scanning electron microscope and atomic force microscope revealed nearly spherical shape NLC with negligible effect of liquid lipid (oleic acid) content on the particle morphology. The differential scanning calorimetry demonstrated depression in the melting point and crystallinity index of the NLCs with increasing the amount of liquid lipid. The in vitro drug release studies demonstrated that 93% of the drug was released over 24hrs. The NEB-NLCs possessed a biphasic release pattern characterized by a rapid initial release followed by a sustained release.

Effects of low doses of esmolol on cardiac and vascular function in experimental septic shock.

BackgroundAdministration of a selective β1-blocker, such as esmolol, in human septic shock has demonstrated cardiovascular protective effects related to heart rate reduction. Certain experimental data also indicate that esmolol exerts systemic anti-inflammatory and beneficial effects on vascular tone. Thus, the present study aimed to determine whether a non-chronotropic dose of esmolol maintains its protective cardiovascular and anti-inflammatory effects in experimental septic shock.MethodsFour hours after cecal ligation and puncture (CLP), Wistar male rats were randomly allocated to the following groups (n = 8): CLP, CLP + E-1 (esmolol: 1 mg.kg−1.h−1), CLP + E-5 (esmolol: 5 mg.kg−1.h−1), CLP + E-18 (esmolol: 18 mg.kg−1.h−1). An additional eight rats underwent sham operation. All rats received a continuous infusion of saline, analgesic and antibiotics 4 hours after the surgery. Assessment at 18 hours included in vivo cardiac function assessed by echocardiography and ex vivo vasoreactivity assessed by myography. Circulating cytokine levels (IL-6 and IL-10) were measured by ELISA. Cardiac and vascular protein expressions of p-NF-κB, IκBα, iNOS, p-AKT/AKT and p-eNOS/eNOS were assessed by western blotting.ResultsCLP induced tachycardia, hypotension, cardiac output reduction, hyperlactatemia and vascular hypo-responsiveness to vasopressors. Compared to CLP animals, heart rate was unchanged in CLP + E-1 and CLP + E-5 but was reduced in CLP + E-18. Stroke volume, cardiac output, mean arterial pressure and lactatemia were improved in CLP + E-1 and CLP + E-5, while vascular responsiveness to phenylephrine was only improved in CLP + E-5 and CLP + E-18. Plasma IL-6 levels were decreased in all esmolol groups. p-NF-κB was decreased in both cardiac and vascular tissues in CLP + E-5 and CLP + E-18.ConclusionIn experimental septic shock, low doses of esmolol still improved cardiac function and vasoreactivity. These benefits appear to be associated with a modulation of inflammatory pathways.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1580-2) contains supplementary material, which is available to authorized users.

Intake of selective beta blockers has no impact on survival in patients with epithelial ovarian cancer

Background and objectiveSome authors have claimed a significant impact of β-blocking agents on outcome in epithelial ovarian cancer (EOC). This study investigated the impact of concurrent medication with selective beta blockers (SBB) in patients undergoing primary treatment for EOC. MethodsThe study included all consecutive patients with primary EOC treated in two tertiary gynecological-oncologic units between 1999 and 2014. Medication was retrospectively analyzed by chart review. ResultsThe study cohort comprised 801 patients, of whom 141 (17.6%) had received SBB. Median age of patients without SBB medication was 56years (range: 19–90years) and 64years (range: 41–84years) in patients taking SBB (p<0.001). The main prognostic factor FIGO stage did not differ between both cohorts. 63.8% of patients taking SBB underwent complete tumor resection compared to 74.2% of patients without SBB (p=0.012). Patients without SBB experienced less severe post-operative complications according to the Clavien-Dindo classification (18.8% vs 29.0%; p=0.003). Between the both groups without and with SBB intake, PFS and OS did not differ significantly (PFS: 27months and 24months, p=0.40; OS: 56months and 44, p=0.15). Multivariate analyses did not yield any association between SBB intake and prognosis but confirmed well-known prognostic factors. ConclusionsIntake of selective β-blockers did not influence the prognosis of patients with EOC.

A randomized, open label study of the efficacy of prophylactic 24-h low-dose landiolol for atrial fibrillation in transthoracic esophagectomy

Atrial fibrillation (Af) is one of the common cardiovascular complications after esophagectomy. Low-dose landiolol prevented postoperative Af after administration was previously reported. We evaluated the preventive effects and safety of landiolol, a β1-selective blocker, on postoperative tachycardia (≥120 bpm) or Af after esophagectomy. Eighty consecutive patients scheduled for esophagectomy at our institute between July 2009 and March 2014. Patients were randomly assigned to a landiolol or control group. Landiolol was administrated at 5 μg/kg/min for 24 h after induction of anesthesia. Electrocardiography was monitored continuously for 2 days after surgery. There were no significant differences in patient background between the control group (n = 40) and the landiolol group (n = 39) except for one patient with preoperative Af. Af was identified in only one patient in the control group, and the onset was on the second postoperative day. Overall, the incidence of Af was 1.3 % (1/79). Incidences of tachycardia were 12.5 and 12.8 % in the control group and the landiolol group, respectively. No adverse event was identified. This study could not show the superiority of prophylactic 24-h low-dose landiolol for postoperative Af in transthoracic esophagectomy. High-risk patients might be candidates for preventive landiolol.

If Channel Inhibition With Ivabradine Does Not Improve Cardiac and Vascular Function in Experimental Septic Shock.

Previous studies have suggested that lowering heart rate (HR) by selective β1-blockers improves sepsis-induced cardiac and vascular dysfunction primarily by decreasing proinflammatory pathways. However, the impact of isolated heart rate reduction (HRR) on hemodynamics and inflammatory pathways remains unknown. The present study was designed to assess the effects of HRR by ivabradine, an If channel inhibitor, on cardiovascular function and inflammatory pathways in peritonitis-induced septic shock in rats. Randomized animal study. University research laboratory. Four hours after cecal ligation and puncture (CLP), Wistar rats were randomly allocated to the following groups: CLP (n = 8) and CLP + ivabradine (n = 8, administered per os 4 h after the surgery). Another eight Wistar male rats underwent sham operation. All rats received a continuous infusion of saline (10 mL kg h), analgesic (nalbuphine: 0.2 mg kg h), and antibiotics (imipenem and cilastatin sodium: 10 mg kg) 4 h after the surgery. Assessment at 18 h included hemodynamics, in vivo cardiac function by echocardiography, and ex vivo vasoreactivity by myography. Circulating cytokine levels (TNF-α, IL-6, and IL-10) were measured by ELISA, whereas cardiac and vascular protein expressions of NF-κB/IκBα/iNOS and Akt/eNOS were assessed by Western blotting. Compared with sham animals, CLP induced tachycardia, hypotension, decreased cardiac output, hyperlactatemia, and vascular hyporesponsiveness to vasopressors. Compared with the CLP group, adjunction of ivabradine decreased the HR without any impact on blood pressure, lactatemia, or vascular responsiveness to vasopressors. Adjunction of ivabradine to CLP rats had no impact on TNF-α, IL-6, and IL-10 cytokines, or on the protein expression levels of phosphorylated forms of NF-κB, Akt, eNOS, and degradation of IκBα in cardiac and vascular tissues. Isolated HRR by ivabradine in an experimental model of septic shock does not appear to be associated with any effect on the tested parameters of cardiac function or on vascular responsiveness to vasopressors. Moreover, in this setting, ivabradine does not alter the circulating levels of selected pro/anti-inflammatory cytokines or cardiac and vascular NF-κB/IκBα protein expression levels.

Effects of cardiovascular drugs on TSH serum levels in patients on replacement therapy after thyroidectomy

Hypothyroidism is one of most common endocrine disorders resulting from deficiency of thyroid hormones. The aim of our study was to investigate whether cardiovascular drugs as well as gender, age, body-mass index, and habits, like smoking or drinking coffee affect thyroid-stimulating hormone (TSH) level in hypothyroid patients with thyroxine replacement therapy who suffer from cardiovascular disease. The study was conducted on 150 hypothyroid patients who underwent total thyroidectomy for benign reasons; they were divided into five treatment groups: levothyroxine only group and, according to the drugs they had in therapy alongside levothyroxine, the angiotensinconverting enzyme inhibitors group, the selective β-blockers group, the calcium antagonists group, as well as the nitrates group. A retrospective cohort study was conducted in the Clinical Center Kragujevac, Serbia, during the period of January 2012 to October 2014. All patients' data were collected both from participants' health records and questionnaires that patients completed, including data about habits, like smoking or drinking coffee. TSH values were significantly higher in the group of patients with selective β-blockers in therapy alongside levothyroxine, compared to all the other study groups. The values of TSH level did not significantly differ among the other therapy groups. On the other hand, cigarette smoking was a risk factor that decreased TSH levels in patients on thyroid replacement therapy. Our study shows that selective β-1 blockers can increase, while cigarette smoking can decrease TSH serum levels in hypothyroid patients on thyroid-replacement therapy.

Features of intracardiac hemodynamics disoders in patients with chronic obstructive pulmonary disease complicated by the chronic pulmonary heart disease development and methods for their medical correction

Chronic pulmonary heart disease is a common pathology and has become one of the leading causes of disability and death in recent years [15]. According to the literature, two-thirds of patients with chronic obstructive pulmonary disease die during the period from 15 months to 5 years after the circulatory decompensation onset, which occupies the third place after hypertension and coronary heart disease among causes of death in the age group older than 50 years [14]. Pulmonary hypertension is considered to be the main pathogenetic mechanism of chronic pulmonary heart disease [11]. The mortality rate in patients with chronic pulmonary heart disease is directly related to the level of pulmonary artery systolic blood pressure. Thus, according to literature data, at the pulmonary artery systolic pressure from 30 to 50 mm Hg 4-5-year survival rate is 30%, and at the level of more than 50 mm Hg 5-year survival rate is zero [1]. Thus, pulmonary hypertension is a poor prognostic factor. Furthermore, it is known that the changes identified in the right ventricle amid the pulmonary hypertension are survival predictors in patients with chronic obstructive pulmonary disease [18]. Literature review showed that the hemodynamics feature in patients with chronic pulmonary heart disease is increased pressure in the pulmonary artery, which leads to both ventricles remodeling and in particular to the right heart enlargement, rise of both right and left ventricles diastolic dysfunction, reduced stroke volume and cardiac output. Furthermore, the review describes that such drug classes as angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers and selective β-blockers are successfully used for the revealed disorders correction in patients with chronic pulmonary heart disease.

Evaluating of the effectiveness and safety of the reproduced selective β1-blocker without intrinsic sympathomimetic activity Bidop® in patients with hypertrophic cardiomyopathy

The article assesses the effectiveness of therapy generics Bidop® production of Gedeon Richter (Hungary), designated to improve diastolic function, and treatment of heart failureof patients with hypertrophic cardiomyopathy with predominant hypertrophy of the interventricular septum and symmetrical concentric shape in the absence of obstruction of outflow tract of the left ventricle (LV). The effect of the presence of zones of intramyocardial fibrosis hypertrophied LV departments identified through MRI delayed contrast, to the process of active relaxation.

β-Blockers and Vascular Hemodynamics in Patients With Peripheral Arterial Disease.

Aortic augmentation index (AIx) is a marker of central aortic pressure burden and is modulated by antihypertensive drugs. In patients with peripheral arterial disease (PAD) undergoing antihypertensive treatment, aortic pressures parameters, heart rate-adjusted augmentation index (AIx75), and unadjusted AIx were determined. The (aortic) systolic and diastolic blood pressure did not differ between PAD patients who were taking β-blockers (n=61) and those who were not taking β-blockers (n=80). In patients taking β-blockers, augmentation pressure and pulse pressure were higher than in patients who did not take β-blockers (augmentation pressure, P=.02; pulse pressure, P=.005). AIx75 was lower in PAD patients taking β-blockers than in patients not taking β-blockers (P=.04), while the AIx did not differ between PAD patients taking and not taking β-blockers. The present study demonstrates that β-blockers potentially affect markers of vascular hemodynamics in patients with PAD. Because these markers are surrogates of cardiovascular risk, further studies are warranted to clarify the impact of selective β-blocker treatment on clinical outcome in patients with PAD.

Oral atenolol therapy for proliferating infantile hemangioma: A prospective study.

Propranolol, a lipophilic nonselective β-blocker, has recently been reported to be the treatment of choice for select types of infantile hemangiomas (IHs). Atenolol is a hydrophilic, selective β1-blocker and therefore may be not associated with side effects attributable to β2-adrenergic receptor blockade and lipophilicity. However, the efficacy and safety of atenolol in the treatment of IH are poorly understood. The aim of this study was to evaluate the efficacy and safety of atenolol in the treatment of proliferating IHs.A study of 76 infants between the ages of 5 to 20 weeks with superficial or mixed IH was conducted between August 2013 and March 2015. Oral atenolol was administered in a progressive schedule to 1 mg/kg per day in a single dose. Efficacy was assessed using the Hemangioma Activity Score (HAS) at weeks 0, 1, 4, 12, and 24. Safety was evaluated at weeks 0, 1, 4, 8, 12, 16, 20, and 24.In total, 70 patients completed 24 weeks of treatment. IH growth abruptly stopped for 93.4% of patients within the fourth week of treatment with atenolol. In ulcerated IHs, complete healing of the ulcerations occurred in an average treatment time of 5.5 weeks. Atenolol treatment promoted dramatic decreases in HAS scores after week 1. An “excellent” treatment response (compete or nearly complete resolution of the IH) was observed in 56.5% of patients at week 24. No significant hypoglycemia, bronchospasm, bradycardia, or hypotension occurred. The most common adverse event was diarrhea, followed by agitation and sleep disturbance.This study demonstrated that atenolol was effective and safe at a dose of 1 mg/kg per day for 24 weeks in the treatment of proliferating IHs.