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Franz H Messerli - One of the best experts on this subject based on the ideXlab platform.
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Misconceptions and Facts About Beta-Blockers.
The American journal of medicine, 2019Co-Authors: Edgar Argulian, Sripal Bangalore, Franz H MesserliAbstract:Beta-Blockers are commonly used medications, and they have been traditionally considered "cardioprotective." Their clinical use appears to be more widespread than the available evidence base supporting their role in cardioprotection. Beta-Blockers counteract neurohumoral activation in heart failure with reduced ejection fraction and offer both symptomatic improvement and reduction in adverse events. On the other hand, the use of Beta-Blockers in uncomplicated hypertension results in suboptimal outcomes compared to the established first-line antihypertensive agents. Providers at all levels should be familiar with common misconceptions regarding Beta-blocker use in routine clinical practice.
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Beta Blockers in heart failure with preserved ejection fraction a meta analysis
Heart Failure Reviews, 2015Co-Authors: Chirag Bavishi, Saurav Chatterjee, Sameer Ather, Dipen Patel, Franz H MesserliAbstract:Beta-Blockers are established drugs in heart failure with reduced ejection fraction, but their role in heart failure with preserved ejection fraction (HFpEF) is not established. Hence, we undertook a meta-analysis to evaluate the efficacy of Beta-Blockers on mortality and morbidity in HFpEF patients. A systematic search using PubMed, Embase, Scopus and Cochrane databases was performed to identify all relevant studies on Beta-Blockers and HFpEF. A random-effects model was performed to assess the role of Beta-Blockers on all-cause mortality and HF hospitalization. Overall 15 observational studies and two randomized control trial involving a total of 27,099 patients were included in the analysis. In the observational studies, Beta-blocker therapy was associated with lower all-cause mortality [RR 0.81 (0.72-0.90), p < 0.001], but not HF hospitalization [RR 0.79 (0.57-1.10), p < 0.001]. However, in the two RCTs, the use of Beta-blocker was not associated with all-cause mortality [RR 0.94 (0.67-1.32), p = 0.72] or HF hospitalization [0.90 (0.54-1.49), p = 0.68]. The results were consistent by geographic region (USA vs. rest of world) and ejection fraction subgroups. Subgroup analysis revealed that the beneficial survival effect of Beta-blocker was limited to studies with mean age <75 years. Observational studies showed a significant benefit from the use of Beta-Blockers for all-cause mortality, but not for HF hospitalization. Beta-Blockers in the two RCTs were not associated with significant reduction in all-cause mortality or HF hospitalization; however, both the trials were not adequately powered and had high loss to follow-up rates. Further large sampled well-conducted randomized trials are warranted to confirm the effects of Beta-Blockers on mortality and hospitalization.
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Cardioprotection with Beta-Blockers: myths, facts and Pascal's wager.
Journal of internal medicine, 2009Co-Authors: Franz H Messerli, Sripal Bangalore, Siu-sun Yao, Jonathan S. SteinbergAbstract:Beta-Blockers were documented to reduce reinfarction rate more than 3 decades ago and subsequently touted as being cardioprotective for a broad spectrum of cardiovascular indications such as hypertension, diabetes, angina, atrial fibrillation as well as perioperatively in patients undergoing surgery. However, despite lowering blood pressure, Beta-Blockers have never shown to reduce morbidity and mortality in uncomplicated hypertension. Also, Beta-Blockers do not prevent heart failure in hypertension any better than any other antihypertensive drug class. Beta-Blockers have been shown to increase the risk on new onset diabetes. When compared with nondiuretic antihypertensive drugs, Beta-Blockers increase all-cause mortality by 8% and stroke by 30% in patients with new onset diabetes. Beta-Blockers are useful for rate control in patients with chronic atrial fibrillation but do not help restore sinus rhythm or have antifibrillatory effects in the atria. Beta-Blockers provide symptomatic relief in patients with chronic stable angina but do not reduce the risk of myocardial infarction. Adverse effects of Beta-Blockers are common including fatigue, dizziness, depression and sexual dysfunction. However, Beta-Blockers remain a cornerstone in the management of patients having suffered a myocardial infarction and for patients with heart failure. Thus, recent evidence argues against universal cardioprotective properties of Beta-Blockers but attest to their usefulness for specific cardiovascular indications.
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cardiovascular protection using Beta Blockers a critical review of the evidence
Journal of the American College of Cardiology, 2007Co-Authors: Sripal Bangalore, Franz H Messerli, John B Kostis, Carl J PepineAbstract:For more than 3 decades, Beta-Blockers have been widely used in the treatment of hypertension and are still recommended as first-line agents by national and international guidelines. Recent meta-analyses indicate that, in patients with uncomplicated hypertension, compared with other antihypertensive agents, first-line therapy with Beta-Blockers was associated with an increased risk of stroke, especially in the elderly cohort with no benefit for the end points of all-cause mortality, cardiovascular morbidity, and mortality. In this review, we critically analyze the evidence supporting the use of Beta-Blockers in patients with hypertension and evaluate evidence for its role in other indications. The review of the currently available literature shows that in patients with uncomplicated hypertension, there is a paucity of data or absence of evidence to support use of Beta-Blockers as monotherapy or as first-line agents. Given the increased risk of stroke, their "pseudo-antihypertensive" efficacy (failure to lower central aortic pressure), lack of effect on regression of target end organ effects like left ventricular hypertrophy and endothelial dysfunction, and numerous adverse effects, the risk benefit ratio for Beta-Blockers is not acceptable for this indication. However, Beta-Blockers remain very efficacious agents for the treatment of heart failure, certain types of arrhythmia, hypertropic obstructive cardiomyopathy, and in patients with prior myocardial infarction.
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How useful are Beta-Blockers in cardiovascular disease?
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2006Co-Authors: Sripal Bangalore, Sanobar Parkar, Franz H MesserliAbstract:Recent studies have shown that Beta-Blockers in patients with hypertension is associated with an increased risk of cardiovascular events, in particular stroke, leading to headlines speculating the end of the Beta-blocker era. The objective of this review is to critically examine the usefulness of Beta-Blockers in cardiovascular diseases. We reviewed the currently available evidence for the usefulness of Beta-Blockers in patients with hypertension and also assessed the efficacy of its use for other indications, like, chronic heart failure, stable angina, myocardial infarction, arrhythmias etc. The review of the currently available literature shows that for patients with uncomplicated hypertension, there is paucity of data or absence of evidence to support use of Beta-Blockers as monotherapy or as first line agent. Given the risk of stroke and numerous unacceptable adverse effects, the risk benefit ratio for Beta-Blockers is not acceptable for this indication. However, Beta-Blockers are very efficacious agents for the treatment of heart failure, certain types of arrhythmia, and post myocardial infarction. The various guideline committees should seriously reconsider their decision about their endorsement of Beta-Blockers as first line therapy for uncomplicated hypertension. However, this is applicable for hypertension and Beta-Blockers continue to be efficacious for other indications.
Shelley R Salpeter - One of the best experts on this subject based on the ideXlab platform.
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cardioselective Beta Blockers for chronic obstructive pulmonary disease
Cochrane Database of Systematic Reviews, 2005Co-Authors: Shelley R Salpeter, Thomas M Ormiston, E E SalpeterAbstract:Background Beta-blocker therapy has a proven mortality benefit in patients with hypertension, heart failure and coronary artery disease, as well as during the perioperative period. These drugs have traditionally been considered contraindicated in patients with chronic obstructive pulmonary disease (COPD). Objectives To assess the effect of cardioselective Beta-Blockers on respiratory function of patients with COPD. Search methods A comprehensive search of the Cochrane Airways Group Specialised Register (derived from systematic searches of CENTRAL, MEDLINE, EMBASE and CINAHL) was carried out to identify randomised blinded controlled trials from 1966 to August 2010. We did not exclude trials on the basis of language. Selection criteria Randomised, blinded, controlled trials of single dose or longer duration that studied the effects of cardioselective Beta-Blockers on the forced expiratory volume in one second (FEV1) or symptoms in patients with COPD. Data collection and analysis Two independent reviewers extracted data from the selected articles, reconciling differences by consensus. Two interventions studied were the administration of Beta-blocker, given either as a single dose or for longer duration, and the use of Beta2-agonist given after the study drug. Main results Eleven studies of single-dose treatment and 11 of treatment for longer durations, ranging from 2 days to 16 weeks, met selection criteria. Cardioselective Beta-Blockers, given as a single dose or for longer duration, produced no change in FEV1 or respiratory symptoms compared to placebo, and did not affect the FEV1 treatment response to Beta2-agonists. Subgroup analyses revealed no significant change in results for those participants with severe chronic airways obstruction, those with a reversible obstructive component, or those with concomitant cardiovascular disease. Authors' conclusions Cardioselective Beta-Blockers, given to patients with COPD in the identified studies did not produce adverse respiratory effects. Given their demonstrated benefit in conditions such as heart failure, coronary artery disease and hypertension, cardioselective Beta-Blockers should not be routinely withheld from patients with COPD.
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cardioselective Beta Blockers for chronic obstructive pulmonary disease a meta analysis
Respiratory Medicine, 2003Co-Authors: Shelley R Salpeter, Thomas M Ormiston, E E Salpeter, Phillippa Poole, Christopher J CatesAbstract:Beta-blocker therapy has a mortality benefit in patients with hypertension, heart failure and coronary artery disease, as well as during the perioperative period. These drugs have traditionally been considered contraindicated in patients with chronic obstructive pulmonary disease (COPD). The objective of this study was to assess the effect of cardioselective Beta-Blockers on respiratory function of patients with COPD. Comprehensive searches were performed of the EMBASE, MEDLINE and CINAHL databases from 1966 to May 2001, and identified articles and related reviews were scanned. Randomised, blinded, controlled trials that studied the effects of cardioselective Beta-Blockers on the forced expiratory volume in 1 s (FEV1) or symptoms in patients with COPD were included in the analysis. Interventions studied were the administration of Beta-blocker, given either as a single dose or for longer duration, and the use of Beta2-agonist given after the study drug. Outcomes measured were the change in FEV1 from baseline and the number of patients with respiratory symptoms. Eleven studies of single-dose treatment and 8 of continued treatment were included. Cardioselective Beta-Blockers produced no significant change in FEV1 or respiratory symptoms compared to placebo, given as a single dose (-2.05% [95% CI, -6.05% to 1.96%]) or for longer duration (-2.55% [CI, -5.94% to 0.84]), and did not significantly affect the FEV1 treatment response to Beta2-agonists. Subgroup analyses revealed no significant change in results for those participants with severe chronic airways obstruction or for those with a reversible obstructive component. In conclusion, cardioselective Beta-Blockers given to patients with COPD do not produce a significant reduction in airway function or increase the incidence of COPD exacerbations. Given their demonstrated benefit in conditions such as heart failure, coronary artery disease and hypertension, cardioselective Beta-Blockers should be considered for patients with COPD.
Mark T. Dransfield - One of the best experts on this subject based on the ideXlab platform.
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effect of Beta Blockers on exacerbation rate and lung function in chronic obstructive pulmonary disease copd
Respiratory Research, 2017Co-Authors: Sean Duffy, R Marron, Helen Voelker, Richard K Albert, John E Connett, William C Bailey, Richard Casaburi, Allen J D Cooper, Jeffrey L Curtis, Mark T. DransfieldAbstract:Beta-Blockers are commonly prescribed for patients with cardiovascular disease. Providers have been wary of treating chronic obstructive pulmonary disease (COPD) patients with Beta-Blockers due to concern for bronchospasm, but retrospective studies have shown that cardio-selective Beta-Blockers are safe in COPD and possibly beneficial. However, these benefits may reflect symptom improvements due to the cardiac effects of the medication. The purpose of this study is to evaluate associations between Beta-blocker use and both exacerbation rates and longitudinal measures of lung function in two well-characterized COPD cohorts. We retrospectively analyzed 1219 participants with over 180 days of follow up from the STATCOPE trial, which excluded most cardiac comorbidities, and from the placebo arm of the MACRO trial. Primary endpoints were exacerbation rates per person-year and change in spirometry over time in association with Beta blocker use. Overall 13.9% (170/1219) of participants reported taking Beta-Blockers at enrollment. We found no statistically significant differences in exacerbation rates with respect to Beta-blocker use regardless of the prevalence of cardiac comorbidities. In the MACRO cohort, patients taking Beta-Blockers had an exacerbation rate of 1.72/person-year versus a rate of 1.71/person-year in patients not taking Beta-Blockers. In the STATCOPE cohort, patients taking Beta-Blockers had an exacerbation rate of 1.14/person-year. Patients without Beta-Blockers had an exacerbation rate of 1.34/person-year. We found no detrimental effect of Beta Blockers with respect to change in lung function over time. We found no evidence that Beta-blocker use was unsafe or associated with worse pulmonary outcomes in study participants with moderate to severe COPD.
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Beta-Blockers in COPD: time for reappraisal
The European respiratory journal, 2016Co-Authors: Brian Lipworth, Jadwiga A. Wedzicha, Graham Devereux, Jørgen Vestbo, Mark T. DransfieldAbstract:The combined effects on the heart of smoking and hypoxaemia may contribute to an increased cardiovascular burden in chronic obstructive pulmonary disease (COPD). The use of Beta-Blockers in COPD has been proposed because of their known cardioprotective effects as well as reducing heart rate and improving systolic function. Despite the proven cardiac benefits of Beta-Blockers post-myocardial infarction and in heart failure they remain underused due to concerns regarding potential bronchoconstriction, even with cardioselective drugs. Initiating treatment with Beta-Blockers requires dose titration and monitoring over a period of weeks, and Beta-Blockers may be less well tolerated in older patients with COPD who have other comorbidities. Medium-term prospective placebo-controlled safety studies in COPD are warranted to reassure prescribers regarding the pulmonary and cardiac tolerability of Beta-Blockers as well as evaluating their potential interaction with concomitant inhaled long-acting bronchodilator therapy. Several retrospective observational studies have shown impressive reductions in mortality and exacerbations conferred by Beta-Blockers in COPD. However, this requires confirmation from long-term prospective placebo-controlled randomised controlled trials. The real challenge is to establish whether Beta-Blockers confer benefits on mortality and exacerbations in all patients with COPD, including those with silent cardiovascular disease where the situation is less clear.
E E Salpeter - One of the best experts on this subject based on the ideXlab platform.
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cardioselective Beta Blockers for chronic obstructive pulmonary disease
Cochrane Database of Systematic Reviews, 2005Co-Authors: Shelley R Salpeter, Thomas M Ormiston, E E SalpeterAbstract:Background Beta-blocker therapy has a proven mortality benefit in patients with hypertension, heart failure and coronary artery disease, as well as during the perioperative period. These drugs have traditionally been considered contraindicated in patients with chronic obstructive pulmonary disease (COPD). Objectives To assess the effect of cardioselective Beta-Blockers on respiratory function of patients with COPD. Search methods A comprehensive search of the Cochrane Airways Group Specialised Register (derived from systematic searches of CENTRAL, MEDLINE, EMBASE and CINAHL) was carried out to identify randomised blinded controlled trials from 1966 to August 2010. We did not exclude trials on the basis of language. Selection criteria Randomised, blinded, controlled trials of single dose or longer duration that studied the effects of cardioselective Beta-Blockers on the forced expiratory volume in one second (FEV1) or symptoms in patients with COPD. Data collection and analysis Two independent reviewers extracted data from the selected articles, reconciling differences by consensus. Two interventions studied were the administration of Beta-blocker, given either as a single dose or for longer duration, and the use of Beta2-agonist given after the study drug. Main results Eleven studies of single-dose treatment and 11 of treatment for longer durations, ranging from 2 days to 16 weeks, met selection criteria. Cardioselective Beta-Blockers, given as a single dose or for longer duration, produced no change in FEV1 or respiratory symptoms compared to placebo, and did not affect the FEV1 treatment response to Beta2-agonists. Subgroup analyses revealed no significant change in results for those participants with severe chronic airways obstruction, those with a reversible obstructive component, or those with concomitant cardiovascular disease. Authors' conclusions Cardioselective Beta-Blockers, given to patients with COPD in the identified studies did not produce adverse respiratory effects. Given their demonstrated benefit in conditions such as heart failure, coronary artery disease and hypertension, cardioselective Beta-Blockers should not be routinely withheld from patients with COPD.
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cardioselective Beta Blockers for chronic obstructive pulmonary disease a meta analysis
Respiratory Medicine, 2003Co-Authors: Shelley R Salpeter, Thomas M Ormiston, E E Salpeter, Phillippa Poole, Christopher J CatesAbstract:Beta-blocker therapy has a mortality benefit in patients with hypertension, heart failure and coronary artery disease, as well as during the perioperative period. These drugs have traditionally been considered contraindicated in patients with chronic obstructive pulmonary disease (COPD). The objective of this study was to assess the effect of cardioselective Beta-Blockers on respiratory function of patients with COPD. Comprehensive searches were performed of the EMBASE, MEDLINE and CINAHL databases from 1966 to May 2001, and identified articles and related reviews were scanned. Randomised, blinded, controlled trials that studied the effects of cardioselective Beta-Blockers on the forced expiratory volume in 1 s (FEV1) or symptoms in patients with COPD were included in the analysis. Interventions studied were the administration of Beta-blocker, given either as a single dose or for longer duration, and the use of Beta2-agonist given after the study drug. Outcomes measured were the change in FEV1 from baseline and the number of patients with respiratory symptoms. Eleven studies of single-dose treatment and 8 of continued treatment were included. Cardioselective Beta-Blockers produced no significant change in FEV1 or respiratory symptoms compared to placebo, given as a single dose (-2.05% [95% CI, -6.05% to 1.96%]) or for longer duration (-2.55% [CI, -5.94% to 0.84]), and did not significantly affect the FEV1 treatment response to Beta2-agonists. Subgroup analyses revealed no significant change in results for those participants with severe chronic airways obstruction or for those with a reversible obstructive component. In conclusion, cardioselective Beta-Blockers given to patients with COPD do not produce a significant reduction in airway function or increase the incidence of COPD exacerbations. Given their demonstrated benefit in conditions such as heart failure, coronary artery disease and hypertension, cardioselective Beta-Blockers should be considered for patients with COPD.
Christopher J Cates - One of the best experts on this subject based on the ideXlab platform.
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cardioselective Beta Blockers for chronic obstructive pulmonary disease a meta analysis
Respiratory Medicine, 2003Co-Authors: Shelley R Salpeter, Thomas M Ormiston, E E Salpeter, Phillippa Poole, Christopher J CatesAbstract:Beta-blocker therapy has a mortality benefit in patients with hypertension, heart failure and coronary artery disease, as well as during the perioperative period. These drugs have traditionally been considered contraindicated in patients with chronic obstructive pulmonary disease (COPD). The objective of this study was to assess the effect of cardioselective Beta-Blockers on respiratory function of patients with COPD. Comprehensive searches were performed of the EMBASE, MEDLINE and CINAHL databases from 1966 to May 2001, and identified articles and related reviews were scanned. Randomised, blinded, controlled trials that studied the effects of cardioselective Beta-Blockers on the forced expiratory volume in 1 s (FEV1) or symptoms in patients with COPD were included in the analysis. Interventions studied were the administration of Beta-blocker, given either as a single dose or for longer duration, and the use of Beta2-agonist given after the study drug. Outcomes measured were the change in FEV1 from baseline and the number of patients with respiratory symptoms. Eleven studies of single-dose treatment and 8 of continued treatment were included. Cardioselective Beta-Blockers produced no significant change in FEV1 or respiratory symptoms compared to placebo, given as a single dose (-2.05% [95% CI, -6.05% to 1.96%]) or for longer duration (-2.55% [CI, -5.94% to 0.84]), and did not significantly affect the FEV1 treatment response to Beta2-agonists. Subgroup analyses revealed no significant change in results for those participants with severe chronic airways obstruction or for those with a reversible obstructive component. In conclusion, cardioselective Beta-Blockers given to patients with COPD do not produce a significant reduction in airway function or increase the incidence of COPD exacerbations. Given their demonstrated benefit in conditions such as heart failure, coronary artery disease and hypertension, cardioselective Beta-Blockers should be considered for patients with COPD.