Comparación de la equivalencia terapéutica de dos productos de bisoprolol - hidroclorotiazida en pacientes con hipertensión arterial / Comparison of two products containing bisoprolol - hydrochlorothiazide therapeutic equivalence in patients with arterial hypertension

Resumen Objetivo: Evaluar la equivalencia terapéutica de dos marcas comerciales de bisoprolol -hidroclorotiazida como terapia antihipertensiva. Método: Estudio prospectivo, doble ciego, doble falso, aleatorizado, de grupos paralelos, en el que se evaluó el efecto antihipertensivo de la combinación de bisoprolol-hidroclorotiazida 2,5-6,25 y 5-6,25 mg (comprimidos BHL, formulación test) y bisoprolol-hidroclorotiazida 2,5-6,25 y 5-6,25 mg tabletas (BHM, formulación de referencia), administrados en pacientes con hipertensión arterial. Variables de efectividad: Presiones arteriales medidas mediante mediante esfigmomanómetro de mercurio al inicio y después del período placebo, a las 4 y 8 semanas del inicio del tratamiento; cambios horarios de la presión arterial durante 24 horas, mediante monitorización ambulatoria de la presión arterial. Resultados: El control de los valores de presión arterial se logró en ambas formulaciones, principalmente a partir de la cuarta semana de tratamiento. Los pacientes del grupo test ingresaron con presiones arteriales sistólicas más elevadas. Después del tratamiento no hubo diferencias entre los grupos, a ninguno de los tiempos. La relación V/P del grupo test fue 0,5-1. Los índices de suavidad de ambos fueron mayores a 1,75. Conclusiones: La formulación test de la combinación de bisoprolol-hidroclotiazida demostró acción antihipertensiva similar al compararla con la formulación de referencia.

Abstract Objective: To evaluate the therapeutic equivalence of two commercial brands of bisoprolol -hydrochlorothiazide as antihypertensive therapy. Method: A prospective, double blind, double placebo, randomised, parallel group study was conducted, in which the antihypertensive effect of the bisoprolol -hydrochlorothiazide 2.5 - 6.25 mg and 5 - 6.25 mg (tablets BHL, test formula) and bisoprolol -hydrochlorothiazide 2.5 - 6.25 mg and 5 - 6.25 mg tablets (BHM, reference formula), was compared by administering it to patients with arterial hypertension given to patients with arterial hypertension. Effectivity variables: blood pressures measured using a mercury sphygmomanometer at the beginning and after the placebo period, at 4 weeks and 8 weeks from the start of the treatment; blood pressure hours change during 24 hours using an ambulatory blood pressure monitoring device. Results: Control of the blood pressure values was achieved with both formulas, mainly from the fourth week of treatment. The patients of the test group were admitted with higher systolic blood pressures. After the treatment, there were no differences between the groups at any of the times. The V/P ratio of the test group was 0.5 - 1. The smoothness index in both groups was greater than 1.75 of fit of both was greater than 1.75. Conclusions: The test formula of the bisoprolol-hydrochlorothiazide demonstrated an antihypertensive action similar to that achieved with the reference formula.

Análise crítica dos estudos que mudaram a prática clínica recente: hipertensão arterial / Critical analysis of studies that changed recent clinical practice: arterial hypertension

Os três estudos que tiveram importante influência na prática clínica de quem trabalha com hipertensão arterial foram os estudos SIMPLICITY HTN-3, PATHWAY 2 e SPRINT. O estudo SIMPLICITY HTN-3 pôs a dúvida um procedimento que já estava sendo utilizado na prática clínica, qual seja, denervação do nervo simpático renal através de ablação por ondas de radiofrequência. Foi o primeiro estudos com grupo controle que não mostrou diferença entre os desfechos específicos de controle da pressão arterial em pacientes com hipertensão resistente. Portanto, o estudo SIMPLICITY HTN 3 modificou a prática clínica no sentido de que todas as diretrizes de hipertensão são unânimes em afirmar que tal procedimento atualmente deva ser reservado para laboratórios específicos de investigação clínica do método e não deve ser empregado como opção estabelecida de tratamento. O estudo PATHWAY 2 consolida o uso do bloqueador de receptor de mineralocorticoides (espironolactona) como o quarto medicamento no fluxograma de tratamento da hipertensão arterial resistente. Os resultados foram tão impactantes que a diretriz europeia de hipertensão arterial mudou substancialmente a orientação da sequência farmacológica do tratamento. Por fim, o estudo SPRINT demonstrou a necessidade de intervenção em pacientes com hipertensão arterial com valores pressóricos abaixo de 140/90 mmHg na dependência da quantidade de risco adicional dos pacientes. Os resultados do estudo SPRINT motivaram alterações ou inclusões de seus dados em várias diretrizes nacionais e internacionais, tais como Sociedade Brasileira de Cardiologia, American Heart Association e European Society of Cardiology

The three studies that have had an important influence on the clinical practice of who works with arterial hypertension were the SIMPLICITY HTN-3, PATHWAY 2 and SPRINT studies. The SIMPLICITY HTN-3 study raised doubts around a procedure that was already being used in clinical practice, the denervation of the sympathetic renal nerve through radiofrequency wave ablation. It was the first study with a control group that did not show a difference between the specific blood pressure control outcomes in patients with resistant hypertension. Therefore, the Simplicity HTN 3 Study modified clinical practice in the sense that all hypertension guidelines are unanimous in stating that currently such a procedure should be reserved for specific clinical investigation laboratories researching the method and should not be used as an established treatment option. The PATHWAY2 study consolidated the use of the mineralocorticoid receptor blocker (spironolactone) as the fourth drug in the resistant arterial hypertension treatment flowchart. The results were so impactful that the European guideline for arterial hypertension changed its orientation around the pharmacological sequence of resistant hypertension treatment substantially. Finally, the SPRINT study demonstrated the need for intervention in patients with arterial hypertension with pressure values below 140/90 mmHg, depending on the amount of additional cardiovascular risk in those patients. The results of the SPRINT study promoted changes to or inclusions of its data in various national and international guidelines, such as the Brazilian Society of Cardiology, the American Heart Association and the European Society of Cardiology

Cost-Effectiveness of Rate- and Rhythm-Control Drugs for Treating Atrial Fibrillation in Korea

PURPOSE: Although the economic and mortality burden of atrial fibrillation (AF) is substantial, it remains unclear which treatment strategies for rate and rhythm control are most cost-effective. Consequently, economic factors can play an adjunctive role in guiding treatment selection. MATERIALS AND METHODS: We built a Markov chain Monte Carlo model using the Korean Health Insurance Review & Assessment Service database. Drugs for rate control and rhythm control in AF were analyzed. Cost-effective therapies were selected using a cost-effectiveness ratio, calculated by net cost and quality-adjusted life years (QALY). RESULTS: In the National Health Insurance Service data, 268149 patients with prevalent AF (age ≥18 years) were identified between January 1, 2013 and December 31, 2015. Among them, 212459 and 55690 patients were taking drugs for rate and rhythm control, respectively. Atenolol cost $714/QALY. Among the rate-control medications, the cost of propranolol was lowest at $487/QALY, while that of carvedilol was highest at $1363/QALY. Among the rhythm-control medications, the cost of pilsicainide was lowest at $638/QALY, while that of amiodarone was highest at $986/QALY. Flecainide and propafenone cost $834 and $830/QALY, respectively. The cost-effectiveness threshold of all drugs was lower than $30000/QALY. Compared with atenolol, the rate-control drugs propranolol, betaxolol, bevantolol, bisoprolol, diltiazem, and verapamil, as well as the rhythm-control drugs sotalol, pilsicainide, flecainide, propafenone, and dronedarone, showed better incremental cost-effectiveness ratios. CONCLUSION: Propranolol and pilsicainide appear to be cost-effective in patients with AF in Korea assuming that drug usage or compliance is the same.

Insuficiência cardíaca - fisiopatologia atual e implicações terapêuticas / Heart failure - current pathophysiology and terapeutic implications

Conhecer a fisiopatologia da insuficiência cardíaca propiciou uma evolução terapêutica em seu manejo, que se traduziu em melhora de desfechos clínicos relevantes, incluindo redução da mortalidade. O conceito do remodelamento ventricular, associado à ativação neuro-humoral descrita inicialmente, via ativação do sistema renina-angiotensina-aldosterona, e posteriormente via ativação simpática, levou ao uso de inibidores da ECA e de betabloqueadores, respectivamente, que mudaram o curso da história da insuficiência cardíaca. Ainda na categoria farmacológica, mais recentemente a modulação da rota da neprilisina, através do uso do composto sacubitril/valsartan, trouxe impacto adicional de redução de mortalidade em pacientes com insuficiência cardíaca. Por fim, dispositivos que também interfiram no processo de remodelamento ventricular, como marcapassos de ressincronização biventricular, demonstraram benefícios clínicos significativos. Novos alvos moleculares, microRNAs ou moléculas de sinalização intracelular, devem crescer como potenciais áreas de investigação na progressão da doença e, potencialmente, se transformarem em alvos terapêuticos

Knowledge of the pathophysiology of heart failure has led to a therapeutic evolution in its management that has resulted in improved clinical outcomes, including a reduction in mortality. The concept of ventricular remodeling associated with neurohumoral activation, initially described via activation of the renin-angiotensin-aldosterone system and later, via sympathetic activation, led to the use of ACE inhibitors and beta blockers, respectively, altering the course of history of heart failure. Also in the pharmacological category, more recently, modulation of the neprilysin route, through the use of the compound sacubitril/valsartan, brought additional impacts in reducing mortality in patients with heart failure. Finally, devices that also interfere in the process of ventricular remodeling, such as biventricular resynchronization pacemakers, have demonstrated significant clinical benefits. New molecular targets, microRNAs, or intracellular signaling molecules should increase as potential areas of research on disease progression, and could potentially become therapeutic targets

Analysis of Medical Treatment Interest Trend in Rural Environment by Big Data / 의료커뮤니케이션

BACKGROUND: In the rural environment, medicine treatment has analyzed the health behavior of some rural areas, but it is necessary to study and generalize trends of interest in the whole country. Therefore, The objective of this study is to analyze interest trends of rural health care services of rural residents in rural areas by Big Data.METHODS: Big medical data collection related to rural environment medicine treatment used portal site data of social networks. The Big Data was analyzed utilizing a Textom and Ucinet6 analysis tools.RESULTS: Among the major keywords of Big Data are ‘hospital’, ‘university’, ‘management’, ‘seat’, ‘improvement’, ‘residents’, ‘information’, ‘exercise’, ‘development’, ‘problem’, ‘Pain’, ‘Possibility’, ‘Post’, ‘Work’, ‘Relationship’ etc occupy a high rank in all analyzes such as frequency ranking, total network analysis, 4 centrality and CONCOR analysis. In rural environment medicine, the individual diseases of interest were skin, scars, atopy, acne, eyes, hyperlipidemia, stress and so on. It is also possible to find out whether the program, the longevity person, the cultivation, the village, the farm, the activity, the program, the education, the experience, etc.CONCLUSION: In the rural areas, they are interested in the folk medicine that can be used in the rural areas for the treatment of the diseases related to the rural areas.The lack of treatment for children and women indicated that professional information was needed, and they also expressed interest in food, life, and spatial location for long-lived villages. Specially, “atopy” and “earnestness” were included in the main words. The word ‘health center’, which is the subject of various health promotion projects, was not included in the 170 main words.

Impact of Heart Rate Reduction with Maximal Tolerable Dose of Bisoprolol on Left Ventricular Reverse Remodeling

BACKGROUND: We aimed to evaluate effect of heart rate (HR) reduction on left ventricular reverse remodeling (LVRR) in Korean patients with heart failure with reduced ejection fraction (HFrEF). METHODS: Ambulatory patients with HFrEF, who had paired echocardiograms, N-terminal prohormone brain natriuretic peptide (NT-proBNP), and global assessment score (GAS) at baseline and 6-month (n = 157), were followed up on preset treatment schedule with bisoprolol. RESULTS: The LVRR occurred in 49 patients (32%) at 6-month. In multivariable analysis, independent predictors associated with LVRR were use of anti-aldosterone agent (odds ratio [OR], 4.18; 95% confidence interval [CI], 1.80–9.71), young age (OR, 0.96; 95% CI, 0.92–0.99), high baseline HR (OR, 3.76; 95% CI, 1.40–10.10), and favorable baseline GAS (OR, 1.73; 95% CI, 1.06–2.81). Beneficial effect of bisoprolol, in terms of LVRR, NT-proBNP, and GAS, was remarkable in the high HR group (baseline HR ≥ 75 beats per minute [bpm]), which showed a large HR reduction. CONCLUSION: High baseline HR (≥ 75 bpm) showed an association with LVRR and improvement of NT-proBNP and GAS in patients with HFrEF. This seems to be due to a large HR reduction after treatments with bisoprolol. Trial registry at www.ClinicalTrials.gov, NCT00749034.

Effects of Bisoprolol Are Comparable with Carvedilol in Secondary Prevention of Acute Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention / 전남의대학술지

Although the benefits of carvedilol have been demonstrated in the era of percutaneous coronary intervention (PCI), very few studies have evaluated the efficacy of bisoprolol in the secondary prevention of acute myocardial infarction (MI) in patients treated with PCI. We hypothesized that the effect of bisoprolol would not be different from carvedilol in post-MI patients. A total of 13,813 patients who underwent PCI were treated either with carvedilol or bisoprolol at the time of discharge. They were enrolled from the Korean Acute MI Registry (KAMIR). After 1:2 propensity score matching, 1,806 patients were enrolled in the bisoprolol group and 3,612 patients in the carvedilol group. The primary end point was the composite of major adverse cardiac events (MACEs), which was defined as cardiac death, nonfatal MI, target vessel revascularization, and coronary artery bypass surgery. The secondary end point was defined as all-cause mortality, cardiac death, nonfatal MI, any revascularization, or target vessel revascularization. After adjustment for differences in baseline characteristics by propensity score matching, the MACE-free survival rate was not different between the groups (HR=0.815, 95% CI:0.614–1.081, p=0.156). In the subgroup analysis, the cumulative incidence of MACEs was lower in the bisoprolol group in patients having a Killip class of III or IV than in the carvedilol group (HR=0.512, 95% CI: 0.263–0.998, p=0.049). The incidence of secondary end points was similar between the two beta-blocker groups. In conclusion, the benefits of bisoprolol were comparable with those of carvedilol in the secondary prevention of acute MI.

Análise da variação do limiar de captura após a realização de cardioversão elétrica em portadores de dispositivos cardíacos eletrônicos implantáveis / Captured threshold variance analysis after electric cardioversion in patients using cardiaca implantable electronic devices

Introdução: Com o aumento da expectativa de vida da população e a consequente maior incidência de arritmias, que podem necessitar de cardioversão elétrica e crescente desenvolvimento e indicação de dispositivos cardíacos eletrônicos implantáveis, torna-se necessária a reavaliação do comportamento desses dispositivos após a aplicação de terapia elétrica, especialmente naqueles pacientes dependentes de estimulação. Este trabalho teve como objetivo avaliar a variação do limiar de captura ventricular após choque terapêutico para tratamento de taquiarritmias supraventriculares, em condições de prá- tica clínica diária. Método: Entre julho de 2009 e maio de 2015, foram avaliados pacientes portadores de dispositivos cardíacos eletrônicos implantáveis, na cidade de Araras (SP, Brasil), que necessitaram de cardioversão elétrica, sendo determinados os limiares de captura ventricular antes e imediatamente após a terapia. A avaliação teve como objetivo analisar a variação desse parâmetro, que reflete item de segurança do dispositivo. Resultados: Foram incluídos 12 pacientes tratados em 13 episódios de taquiarritmias supraventriculares (fibrilação e taquicardia atriais), com média de idade de 71,6 anos, predominantemente do sexo masculino, com tempo variável de implante do dispositivo, não sendo encontrada variação significativa do limiar de captura ventricular antes e após a cardioversão elétrica. Conclusão: Não há variação significativa do limiar de captura ventricular após cardioversão elétrica em pacientes com taquiarritmias supraventriculares

Background: With the increase in the population's life expectancy, a greater incidence of cardiac arrhythmias is observed. These arrhythmias may require treatment with electric cardioversion. Furthermore, with the increase in the development and indications for cardiac implantable electronic devices, the behavior of these devices after electric therapy must be reevaluated, especially in patients who depended on cardiac stimulation. This study aimed to evaluate the ventricular captured threshold variance after therapeutic countershock for the treatment of supraventricular tachyarrhythmias in daily practice conditions. Method: From July 2009 to May 2015, patients with cardiac implantable electronic devices requiring electric cardioversion were evaluated, in Araras (SP, Brazil). Captured threshold variance before and immediately after therapy was determined. The evaluation aimed at analyzing the variance of this parameter, which reflects a safety feature of the device. Results: 12 patients were included, presenting with 13 episodes of supraventricular tachyarrhythmias (atrial tachycardia and fibrillation). Mean age was 71.6 years, with a prevalence of males and variable device implant times. No significant ventricular captured threshold variation was found before and after electric cardioversion. Conclusion: There is no significant variation of ventricular captured threshold variance after electric cardioversion in patients with supraventricular tachyarrhythmias

A case report on cerebrogenic fatal cardiac arrhythmia in a patient with acute ischemic stroke

BACKGROUND: Patients with acute ischemic stroke are susceptible  to  cardiac  arrhythmias  however,fatal arrhythmias  are  rare  in  the  absence  of  cardiac  disease.Cardiac arrhythmias can develop in lesions at the right side of the brain specifically the insular,frontal and parietal area.Data that show the direct relationship of ischemic stroke and arrhythmia are scarce but they are indirectly attributed to an imbalance in the autonomic nervous system.This paper aims to present a rare case of an association between a fatal arrhythmia and right thalamic infarct.   CASE: Presenting a case of a 39-year-old admitted as a survivor of sudden cardiac death from ventricular fibrillation.She presented with a history of left sided weakness a week prior but no work-up was done. Baseline serum electrolytes and  cardiac markers were all normal.Electrocardiogram (ECG) post-cardioversion showed sinus tachycardia.Echocardiogram   and cardiac computed tomography (CT) angiography were normal.  Magnetic resonance imaging (MRI) and angiography (MRA) of the brain showed an acute infarct at the right thalamus and an absent left internal carotid artery (ICA).Electroencephalogram (EEG) was negative.Bisoprolol was given and an Automatic Implantable Cardioverter Defibrillator (AICD) was subsequently placed.No recurrence of cardiac arrhythmia was noted on continuous cardiac telemetry monitoring during her hospitalization and on six months of follow-up.CONCLUSION: Fatal cardiac arrhythmias, can occur in patients with  acute  thalamic  infarct  even  beyond  24  hours  in  the presence of other confounding factors despite the absence of cardiac pathology. This case showed the association of heightened  autonomic  imbalance  caused  by  an  acute stroke, decreased cerebral flow, and fatal arrhythmia. This elucidates the importance of cardiac monitoring in acute ischemic stroke. With the paucity of information on serious cardiac arrhythmia and ischemic stroke, a future study on this correlation will be useful.

A case report on cerebrogenic fatal cardiac arrhythmia in a patient with acute ischemic stroke

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Patients with acute ischemic stroke are susceptible  to  cardiac  arrhythmias  however,fatal arrhythmias  are  rare  in  the  absence  of  cardiac  disease.Cardiac arrhythmias can develop in lesions at the right side of the brain specifically the insular,frontal and parietal area.Data that show the direct relationship of ischemic stroke and arrhythmia are scarce but they are indirectly attributed to an imbalance in the autonomic nervous system.This paper aims to present a rare case of an association between a fatal arrhythmia and right thalamic infarct.   <br /><strong>CASE:</strong> Presenting a case of a 39-year-old admitted as a survivor of sudden cardiac death from ventricular fibrillation.She presented with a history of left sided weakness a week prior but no work-up was done. Baseline serum electrolytes and  cardiac markers were all normal.Electrocardiogram (ECG) post-cardioversion showed sinus tachycardia.Echocardiogram   and cardiac computed tomography (CT) angiography were normal.  Magnetic resonance imaging (MRI) and angiography (MRA) of the brain showed an acute infarct at the right thalamus and an absent left internal carotid artery (ICA).Electroencephalogram (EEG) was negative.Bisoprolol was given and an Automatic Implantable Cardioverter Defibrillator (AICD) was subsequently placed.No recurrence of cardiac arrhythmia was noted on continuous cardiac telemetry monitoring during her hospitalization and on six months of follow-up.<br /><strong>CONCLUSION:</strong> Fatal cardiac arrhythmias, can occur in patients with  acute  thalamic  infarct  even  beyond  24  hours  in  the presence of other confounding factors despite the absence of cardiac pathology. This case showed the association of heightened  autonomic  imbalance  caused  by  an  acute stroke, decreased cerebral flow, and fatal arrhythmia. This elucidates the importance of cardiac monitoring in acute ischemic stroke. With the paucity of information on serious cardiac arrhythmia and ischemic stroke, a future study on this correlation will be useful.</p>

A case report on cerebrogenic fatal cardiac arrhythmia in a patient with acute ischemic stroke

BACKGROUND: Patients with acute ischemic stroke are susceptible  to  cardiac  arrhythmias  however,fatal arrhythmias  are  rare  in  the  absence  of  cardiac  disease.Cardiac arrhythmias can develop in lesions at the right side of the brain specifically the insular,frontal and parietal area.Data that show the direct relationship of ischemic stroke and arrhythmia are scarce but they are indirectly attributed to an imbalance in the autonomic nervous system.This paper aims to present a rare case of an association between a fatal arrhythmia and right thalamic infarct.   CASE: Presenting a case of a 39-year-old admitted as a survivor of sudden cardiac death from ventricular fibrillation.She presented with a history of left sided weakness a week prior but no work-up was done. Baseline serum electrolytes and  cardiac markers were all normal.Electrocardiogram (ECG) post-cardioversion showed sinus tachycardia.Echocardiogram   and cardiac computed tomography (CT) angiography were normal.  Magnetic resonance imaging (MRI) and angiography (MRA) of the brain showed an acute infarct at the right thalamus and an absent left internal carotid artery (ICA).Electroencephalogram (EEG) was negative.Bisoprolol was given and an Automatic Implantable Cardioverter Defibrillator (AICD) was subsequently placed.No recurrence of cardiac arrhythmia was noted on continuous cardiac telemetry monitoring during her hospitalization and on six months of follow-up.CONCLUSION: Fatal cardiac arrhythmias, can occur in patients with  acute  thalamic  infarct  even  beyond  24  hours  in  the presence of other confounding factors despite the absence of cardiac pathology. This case showed the association of heightened  autonomic  imbalance  caused  by  an  acute stroke, decreased cerebral flow, and fatal arrhythmia. This elucidates the importance of cardiac monitoring in acute ischemic stroke. With the paucity of information on serious cardiac arrhythmia and ischemic stroke, a future study on this correlation will be useful.

A Pregnant Woman with Type 2 Diabetes Unintentionally Exposed to Metformin and Voglibose until the Second Trimester of Pregnancy: A Case Report / 임상당뇨병

Use of oral hypoglycemic agents during pregnant women with type 2 diabetes is controversial due to safety issues. Recently, randomized controlled trials support short-term safety of glyburide and metformin for the treatment of gestational diabetes mellitus. However, long-term safety data are not available. Moreover, use of oral hypoglycemic agents, except for metformin and glyburide, during pregnancy were limited to a few case reports. We report the case of a pregnant woman with type 2 diabetes unintentionally exposed to metformin and voglibose in addition to lercanidipine and bisoprolol during fetal organogenesis. The patient was continuously exposed to oral agents because we were not aware of her pregnancy until 22 weeks of gestation. After pregnancy was confirmed, we replaced oral hypoglycemic agents with insulin and discontinue betablockers. Delivery occurred without maternal or fetal complications.

Impact of the beta-1 adrenergic receptor polymorphism on tolerability and efficacy of bisoprolol therapy in Korean heart failure patients: association between beta adrenergic receptor polymorphism and bisoprolol therapy in heart failure (ABBA) study

BACKGROUND/AIMS: We evaluated the association between coding region variants of adrenergic receptor genes and therapeutic effect in patients with congestive heart failure (CHF). METHODS: One hundred patients with stable CHF (left ventricular ejection fraction [LVEF] < 45%) were enrolled. Enrolled patients started 1.25 mg bisoprolol treatment once daily, then up-titrated to the maximally tolerable dose, at which they were treated for 1 year. RESULTS: Genotypic analysis was carried out, but the results were blinded to the investigators throughout the study period. At position 389 of the beta-1 adrenergic receptor gene (ADRB1), the observed minor Gly allele frequency (Gly389Arg + Gly389Gly) was 0.21, and no deviation from Hardy-Weinberg equilibrium was observed in the genotypic distribution of Arg389Gly (p = 0.75). Heart rate was reduced from 80.8 +/- 14.3 to 70.0 +/- 15.0 beats per minute (p < 0.0001). There was no significant difference in final heart rate across genotypes. However, the Arg389Arg genotype group required significantly more bisoprolol compared to the Gly389X (Gly389Arg + Gly389Gly) group (5.26 +/- 2.62 mg vs. 3.96 +/- 2.05 mg, p = 0.022). There were no significant differences in LVEF changes or remodeling between two groups. Also, changes in exercise capacity and brain natriuretic peptide level were not significant. However, interestingly, there was a two-fold higher rate of readmission (21.2% vs. 10.0%, p = 0.162) and one CHF-related death in the Arg389Arg group. CONCLUSIONS: The ADRB1 Gly389X genotype showed greater response to bisoprolol than the Arg389Arg genotype, suggesting the potential of individually tailoring beta-blocker therapy according to genotype.

Pravastatin-induced Stevens-Johnson syndrome

Stevens-Johnson syndrome (SJS) manifests with severe cutaneous reactions, most commonly triggered by medications, which are characterized by fever and mucocutaneous lesions leading to necrosis and sloughing of the epidermis. To our knowledge, pravastatin-induced SJS has not yet been reported. Here, we describe a case of SJS due to pravastatin, which was diagnosed by a patch test. A 70-year-old woman presented with maculopapular skin rashes, which developed 2 weeks after medication of bisoprolol, amlodipine, pravastatin, spironolactone, and indobufene for cardiac problems. Various bullous-erosive mucocutaneous lesions occupied less than 10% of the total body surface area. Painful oropharyngeal mucous membrane lesions were observed. The vermilion border of the lips became denuded and developed serosanguinous crusts. With the drug withdrawal and the use of systemic corticosteroids, her manifestations resolved. Drug patch tests with bisoprolol, amlodipine, pravastatin, spironolactone, and indobufene were performed, resulting in a positive reaction to pravastatin, but not to the other drugs. To the best of our knowledge, this is the first case of pravastatin-induced SJS.

Assessment of tolerability of beta- blockade therapy in patient with left ventricular systolic dysfunction heart failure

Little data exist to demonstrate the tolerability of beta-blocker therapy in an unselected community heart failure population already treated with the clinical trial or higher dose ACEI or ARB. 141 patients who had left ventricular systolic failure on standard therapy were recruited in our study. Patients were assigned to receive either Carvedilol or Bisoprolol. This prospective observational study showed that beta-blocker therapy is well tolerated and can be safely titrated in an out-patient setting

Comparación de la eficiencia entre el carvedilol y bisoprolol en el manejo de 60 pacientes con insuficiencia cardíaca, hospital Luis Vernaza, controlados desde el 2002 – 2007 / Efficiency comparison between carvedilol and bisoprolol in the treatment of 60 patients with heart failure, Luis Vernaza hospital, controlled from 2002 to 2007

Tipo de Estudio: clínico, comparativo, longitudinal, tipo prospectivo de dos ramas, que se llevó a cabo en la consulta externa del hospital “Luís Vernaza”, de Guayaquil. El universo del estudio constituyó todos los pacientes que ingresaron a la consulta con el diagnóstico de insuficiencia cardíaca congestiva de origen isquémico y no isquémico durante el período comprendido desde junio de 2002 a diciembre de 2007. Objetivos: el principal es demostrar que los betabloqueantes, carvedilol y bisoprolol son igual de eficientes al reducir el riesgo de la progresión de la enfermedad basándonos en la mejoría de los parámetros ecocardiográficos y la clase funcional de los pacientes. Resultados: se reclutaron 60 pacientes con insuficiencia cardíaca de base etiológica isquémica (68,3) y no isquémica (31,7), la edad promedio fue 68,35 (SD 6,089) predominando el género femenino en 56,7. Se encontró mejoría en la FE con un aumento de 36,9 a 42,4 en el grupo de carvedilol y asimismo para el bisoprolol con 33,9 al 43,4 (p=0,083). En cuanto al DDVI en el grupo de carvedilol se reportó un ligero aumento de 57 a 57,5mm en comparación al grupo de bisoprolol donde hubo mejoría al disminuir de 58,8 a 56,8 mm sin mostrar diferencia significativa entre ambos betabloqueantes (p=0,156). El DSVI en ambos grupos tanto para el carvedilol y bisoprolol se lograron reducciones de 45 a 44,4mm y de 47,2 a 44,5mm respectivamente sin mostrar tampoco diferencia estadística (p=0,188). En cuanto al grado funcional los pacientes que previo al tratamiento ingresaron con CF III en 51,9 mejorando a la CF I en 63,5 Conclusiones: el estudio demuestra que ambos betabloqueantes tanto el carvedilol y bisoprolol son igual de eficientes como parte del tratamiento en pacientes con insuficiencia cardíaca congestiva al momento de disminuir el riesgo de progresión de la enfermedad ya que demostró mejoría en sus parámetros ecocardiográficos y en su grado funcional.

Study type: Clinical, comparative, longitudinal, prospective type of two branches that was carried out in outpatient consultation at “Luis Vernaza” hospital of Guayaquil. The crowd for the study were all the patients who entered to the consultation with the congestive heart failure diagnosis of ischemic and non-ischemic origin from June 2002 to December 2007. Objective: The main one is to demonstrate that beta blockers, carvedilol and bisoprolol are both efficient when progression risk is reduced based in the improvement of echocardiography parameters and the functional class of patients. Results: 60 patients with heart failure of etiological ischemic base (68.3) and non-ischemic base (31,7) were recruited, the average age was 68,35 (SD 6,089) predominating the female gender in 56,7. Improvement was evidenced in the FE “Fracción de Eyección” (Ejection Fraction) with an increase of 36,9 to 42,4 in the carvedilol group and likewise for bisoprolol with 33,9 to 43,4 (p=0,083). In terms of DDVI “Diámetro Diastólico del Ventrículo Izquierdo” (Left Ventricle Diastolic Diameter), in the carvidol group a slight increase of 57 to 57,5 mm was reported compared to bisoprolol group where there was improvement when diminishing from 58,8 to 56,8 mm without showing significant difference between both beta blockers (p=0,156). Reductions from 45 to 44,4.and from 47,2 to 44,5mm were also obtained in both groups carvedilol and bisoprolol The DSVI “Diametro Sistolico del Ventriculo Izquierdo” (Left Ventricle Sistolic Diameter, but without showing statistic difference either (p=0,188). As far as the functional rank is concerned, patients who previous to the treatment entered with CF III (Cystic Fibrosis III) in 51,9 improved to the CF I in 63,5.

Comparación de la combinación hidroclorotiazida/bisoprolol con enalapril/amlodipina en el manejo de la hipertensión arterial no controlada / Comparison of the combination hydrochlorothiazide/bisoprolol with enalapril/amlodipine in the management of uncontrolled hypertension

La hipertensión arterial afecta aproximadamente 50 millones de individuos en Estados Unidos de América y un mil millones de individuos en el resto del mundo, afectando de un 15 por ciento a 30 por ciento de la población mundial, y es uno de los factores predictivos de enfermedad cardiovascular más importantes, por lo tanto su control es indispensable. Este estudio comparó la acción antihipertensiva de la combinación hidroclorotiazida/bisoprolol con la combinación enalapril/amlodipina en pacientes con diagnóstico de hipertensión arterial no controlada. Métodos: Se realizó un ensayo clínico controlado aleatorizado en pacientes hipertensos con edades comprendidas entre 30 y 65 años con diagnóstico de hipertensión arterial con o sin tratamiento. Fueron distribuidos en dos grupos de 10 pacientes; uno recibió tratamiento con hidroclorotiazida/bisoprolol y el otro con enalapril/amlodipina bajo un protocolo de ajuste de dosis según metas de PA para 4 semanas. Resultados: Ambas combinaciones redujeron significativamente los valores de presión arterial a las 4 semanas (P=< 0,0001). Sin embargo, el efecto antihipertensivo de la combinación hidroclorotiazida/Bisoprolol fue superior para la reducción de la presión diastólica (P= 0,025), y el alcance de la meta de 120/70 mmHg (90 por ciento vs. 50 por ciento). Conclusión: La utilización de la combinación hidroclorotiazida / bisoprolol tiene mayor número de beneficios que los observados con la combinación enalapril / amlodipina en el manejo de la hipertensión arterial no controlada

The High Blood Pressure affects around 50 millions people in the EE.UU of America and a thousand million people all around the world, affecting 15 percent to 30 percent of the world’s population, and is one of the most important predictive factors of cardiovascular disease; therefore its control is essential. This study compared the antihypertensive action of the combination Hydrochlorothiazide/Bisoprolol with the combination Enalapril/Amlodipine in patients with uncontrolled High Blood Pressure diagnosis. Methods: We performed a randomized, controlled, clinical essay, in patients with High Blood Pressure between 30 and 65 years old, with High Blood Pressure previous diagnosis under treatment or not. They were distributed into two groups of 10 patients each one; one group received Hydrochlorothiazide/Bisoprolol, and the other one, received Enalapril/Amlodipine under a standardized regimen of titration according to BP goals during 4 weeks. Results: Both combinations reduced significantly BP values at 4 weeks of treatment (P= <0.0001). However, the antihypertensive effect of the combination Hydrochlorothiazide/Bisoprolol was superior in the reduction of diastolic values of BP (P= 0,025), and the reach of the 120/70 mmHg goal (90 percent vs. 50 percent). Conclusions: the use of the combination Hydrochlorothiazide/Bisoprolol is related to a higher number of benefits than the use of the combination Enalapril/Amlodipine in the management of patients with uncontrolled High Blood Pressure diagnosis