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3.
Int Heart J ; 62(1): 119-126, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33518651

RESUMO

Tachycardia-induced cardiomyopathy (TIC) is a potentially reversible cardiomyopathy caused by tachyarrhythmia. For atrial flutter (AFL) -induced TIC, a rhythm control strategy, such as catheter ablation, has been recommended. However, the efficacy of rate control has remained unclear due to the difficulty of achieving control using arrhythmic medications.We prospectively assessed 47 symptomatic heart failure (HF) patients with left ventricular ejection fraction (LVEF) < 50% and suspected persistent AFL-induced TIC. Patients were divided into the rhythm control strategy (n = 22; treatment with catheter ablation or electrical cardioversion) and rate control strategy (n = 25; treatment with bisoprolol) groups. The latter was further divided into the strict rate control strategy (average heart rate < 80 bpm) and lenient rate control strategy (average heart rate < 110 bpm) subgroups. The primary outcome was left ventricular (LV) function recovery, which was defined as an increase in LVEF ≥ 20% or to a value of ≥ 55% after 6 months.In the rhythm control strategy group, more patients achieved LV function recovery after 6 months (95.2% versus 60.9%, P = 0.010). The cumulative incidence of worsening HF events was significantly higher in the rate control strategy group than in the rhythm control strategy group (hazard ratio, 4.66; 95% confidence interval, 1.01-21.57). The subgroup study revealed the advantage of the strict rate control strategy for achieving LV function recovery (83.3% versus 36.4%, P = 0.036).The rate control strategy was significantly inferior to the rhythm control strategy for the LV function recovery in TIC patients with persistent AFL. Our findings suggest that the strict rate control strategy should be aimed if the rhythm control strategy cannot be performed.


Assuntos
Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Flutter Atrial/complicações , Bisoprolol/uso terapêutico , Cardiomiopatias/terapia , Taquicardia/terapia , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatias/etiologia , Ablação por Cateter , Cardioversão Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taquicardia/etiologia
4.
JAMA ; 324(24): 2497-2508, 2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33351042

RESUMO

Importance: There is little evidence to support selection of heart rate control therapy in patients with permanent atrial fibrillation, in particular those with coexisting heart failure. Objective: To compare low-dose digoxin with bisoprolol (a ß-blocker). Design, Setting, and Participants: Randomized, open-label, blinded end-point clinical trial including 160 patients aged 60 years or older with permanent atrial fibrillation (defined as no plan to restore sinus rhythm) and dyspnea classified as New York Heart Association class II or higher. Patients were recruited from 3 hospitals and primary care practices in England from 2016 through 2018; last follow-up occurred in October 2019. Interventions: Digoxin (n = 80; dose range, 62.5-250 µg/d; mean dose, 161 µg/d) or bisoprolol (n = 80; dose range, 1.25-15 mg/d; mean dose, 3.2 mg/d). Main Outcomes and Measures: The primary end point was patient-reported quality of life using the 36-Item Short Form Health Survey physical component summary score (SF-36 PCS) at 6 months (higher scores are better; range, 0-100), with a minimal clinically important difference of 0.5 SD. There were 17 secondary end points (including resting heart rate, modified European Heart Rhythm Association [EHRA] symptom classification, and N-terminal pro-brain natriuretic peptide [NT-proBNP] level) at 6 months, 20 end points at 12 months, and adverse event (AE) reporting. Results: Among 160 patients (mean age, 76 [SD, 8] years; 74 [46%] women; mean baseline heart rate, 100/min [SD, 18/min]), 145 (91%) completed the trial and 150 (94%) were included in the analysis for the primary outcome. There was no significant difference in the primary outcome of normalized SF-36 PCS at 6 months (mean, 31.9 [SD, 11.7] for digoxin vs 29.7 [11.4] for bisoprolol; adjusted mean difference, 1.4 [95% CI, -1.1 to 3.8]; P = .28). Of the 17 secondary outcomes at 6 months, there were no significant between-group differences for 16 outcomes, including resting heart rate (a mean of 76.9/min [SD, 12.1/min] with digoxin vs a mean of 74.8/min [SD, 11.6/min] with bisoprolol; difference, 1.5/min [95% CI, -2.0 to 5.1/min]; P = .40). The modified EHRA class was significantly different between groups at 6 months; 53% of patients in the digoxin group reported a 2-class improvement vs 9% of patients in the bisoprolol group (adjusted odds ratio, 10.3 [95% CI, 4.0 to 26.6]; P < .001). At 12 months, 8 of 20 outcomes were significantly different (all favoring digoxin), with a median NT-proBNP level of 960 pg/mL (interquartile range, 626 to 1531 pg/mL) in the digoxin group vs 1250 pg/mL (interquartile range, 847 to 1890 pg/mL) in the bisoprolol group (ratio of geometric means, 0.77 [95% CI, 0.64 to 0.92]; P = .005). Adverse events were less common with digoxin; 20 patients (25%) in the digoxin group had at least 1 AE vs 51 patients (64%) in the bisoprolol group (P < .001). There were 29 treatment-related AEs and 16 serious AEs in the digoxin group vs 142 and 37, respectively, in the bisoprolol group. Conclusions and Relevance: Among patients with permanent atrial fibrillation and symptoms of heart failure treated with low-dose digoxin or bisoprolol, there was no statistically significant difference in quality of life at 6 months. These findings support potentially basing decisions about treatment on other end points. Trial Registration: ClinicalTrials.gov Identifier: NCT02391337 and clinicaltrialsregister.eu Identifier: 2015-005043-13.


Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Bisoprolol/uso terapêutico , Digoxina/uso terapêutico , Frequência Cardíaca/efeitos dos fármacos , Qualidade de Vida , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antiarrítmicos/efeitos adversos , Antiarrítmicos/farmacologia , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Bisoprolol/efeitos adversos , Bisoprolol/farmacologia , Digoxina/efeitos adversos , Digoxina/farmacologia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Volume Sistólico
5.
Wiad Lek ; 73(8): 1712-1716, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33055339

RESUMO

OBJECTIVE: The aim: Study of the patterns of structural changes in the left ventricular myocardial capillaries of rats with arterial hypertension with combined pharmacotherapy with Bisoprolol and Thiotriazolinum. PATIENTS AND METHODS: Materials and methods: Experiments were conducted on 30 line rats with congenital stress-induced arterial hypertension: 10 animals without treatment and 10 animals with treatment. Pharmacological correction of spontaneous arterial hypertension was performed with 20 mg / kg of Bisoprolol and 50 mg / kg of Thiotriazolinum per os once a day. Pharmacotherapy began at 5 months of age, that is, at a time when compensated heart failure was formed in rats with arterial hypertension. Animals were withdrawn from the experiment 100 days after the start of the correction. Control was provided by intact animals (10 rats) of the corresponding age. While extracted from the experiment rats of all experimental groups had their arterial pressure measured using a plethysmograph, electron microscopic examination of the left ventricular myocardium and morphometric study of volumetric and quantitative densities, cross-section area and form factor of micropinocytotic vesicles were conducted. RESULTS: Results: In rats with arterial hypertension after application of Bisoprolol and Thiotriazolinum, arterial pressure significantly decreases in experimental rats compared to animals without correction. The number of capillaries in the myocardium after pharmacotherapy increases up to control values, which shows their reparation. In most endothelial cells, organelles retain their integrity and presence that are characteristic of intact rats. The well-expressed processes of transcytosis are shown by the statistical similarity of the quantitative density and the size of the micropinocytotic vesicles in the endothelial cells of the myocardium capillaries of compared experimental animals. CONCLUSION: Conclusions: In rats with arterial hypertension, the combination of Bisoprolol and Thiotriazolinum prevents the decrease in the number of capillaries in the myocardium of the left ventricle, promotes the preservation of the ultrastructure of their endothelial cells and maintains the processes of transedothelial transfer of substances at the level of intact animals.


Assuntos
Células Endoteliais , Hipertensão , Animais , Bisoprolol/uso terapêutico , Coração , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Miocárdio , Ratos
6.
PLoS One ; 15(3): e0230655, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32208439

RESUMO

BACKGROUND: T-wave area dispersion (TW-Ad) is a novel electrocardiographic (ECG) repolarization marker associated with sudden cardiac death. However, limited data is available on the clinical correlates of TW-Ad. In addition, there are no previous studies on cardiovascular drug effects on TW-Ad. In this study, we examined the relation between TW-Ad and left ventricular mass. We also studied the effects of four commonly used antihypertensive drugs on TW-Ad. METHODS: A total of 242 moderately hypertensive males (age, 51±6 years; office systolic/diastolic blood pressure during placebo, 153±14/100±8 mmHg), participating in the GENRES study, were included. Left ventricular mass index was determined by transthoracic echocardiography. Antihypertensive four-week monotherapies (a diuretic, a beta-blocker, a calcium channel blocker, and an angiotensin receptor antagonist) were administered in a randomized rotational fashion. Four-week placebo periods preceded all monotherapies. The average value of measurements (over 1700 ECGs in total) from all available placebo periods served as a reference to which measurements during each drug period were compared. RESULTS: Lower, i.e. risk-associated TW-Ad values correlated with a higher left ventricular mass index (r = -0.14, p = 0.03). Bisoprolol, a beta-blocker, elicited a positive change in TW-Ad (p = 1.9×10-5), but the three other drugs had no significant effect on TW-Ad. CONCLUSIONS: Our results show that TW-Ad is correlated with left ventricular mass and can be modified favorably by the use of bisoprolol, although demonstration of any effects on clinical endpoints requires long-term prospective studies. Altogether, our results suggest that TW-Ad is an ECG repolarization measure of left ventricular arrhythmogenic substrate.


Assuntos
Anti-Hipertensivos/uso terapêutico , Ventrículos do Coração/fisiopatologia , Hipertensão/tratamento farmacológico , Antagonistas Adrenérgicos beta/farmacologia , Antagonistas Adrenérgicos beta/uso terapêutico , Antagonistas de Receptores de Angiotensina/farmacologia , Antagonistas de Receptores de Angiotensina/uso terapêutico , Anti-Hipertensivos/farmacologia , Bisoprolol/farmacologia , Bisoprolol/uso terapêutico , Pressão Sanguínea , Bloqueadores dos Canais de Cálcio/farmacologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Morte Súbita Cardíaca/prevenção & controle , Diuréticos/farmacologia , Diuréticos/uso terapêutico , Método Duplo-Cego , Ecocardiografia , Ventrículos do Coração/anatomia & histologia , Ventrículos do Coração/efeitos dos fármacos , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Função Ventricular/efeitos dos fármacos
7.
BMJ Case Rep ; 13(2)2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32114494

RESUMO

Flecainide toxicity can result in increased cardiovascular instability which can significantly alter patient outcome if not recognised early. In this case report, the management of a 68-year-old woman who took an unintentional overdose of flecainide is detailed. We look at the management she received in the emergency department and her successful recovery and follow-up since the admission. In addition, the case report outlines the ECG changes that are most commonly documented in flecainide overdose and reviews the frequently used treatment methods for the overdose as summarised in current literature.


Assuntos
Bisoprolol/uso terapêutico , Overdose de Drogas/diagnóstico por imagem , Overdose de Drogas/tratamento farmacológico , Flecainida/toxicidade , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Idoso , Antiarrítmicos/toxicidade , Anti-Hipertensivos/uso terapêutico , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , Humanos
8.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32201574

RESUMO

The management of resistant hypertension presents several challenges in everyday clinical practice. During the past few years, several studies have been performed to identify efficient and safe pharmacological and non-pharmacological options for the management of such patients. The Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2) trial demonstrated significant benefits with the use of spinorolactone as a fourth-line drug for the treatment of resistant hypertension over doxazosin and bisoprolol. In addition, recent data support that spironolactone may demonstrate superiority over central acting drugs in such patients, as well. Based on the European guidelines, spironolactone is recommended as the fourth-line drug option, followed by amiloride, other diuretics, doxazosin, bisoprolol or clonidine.  Among several device-based approaches, renal sympathetic denervation had fallen into hibernation after the disappointing results of the Renal Denervation in Patients With Uncontrolled Hypertension (SYMPLICITY HTN) 3 trial. However, the technique re-emerged at the epicenter of the clinical and research interest after the favorable results of three sham-controlled studies, which facilitated novel catheters and techniques to perform the denervation. Significant results of iliac anastomosis on blood pressure levels have also been demonstrated. Nevertheless, the technique-related adverse events resulted in withdrawal of this interventional approach. Last, the sympatholytic properties of the carotid baroreceptor activation therapy were associated with significant blood pressure reductions in patients with resistant hypertension, which need to be verified in larger controlled trials. Currently device-based approaches are recommended only in the setting of clinical trials until more safety and efficacy data become available.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/terapia , Bisoprolol/uso terapêutico , Cateteres , Ensaios Clínicos como Assunto , Clonidina/uso terapêutico , Denervação , Doxazossina/uso terapêutico , Humanos , Rim , Espironolactona/uso terapêutico
9.
Am J Ther ; 27(2): e159-e164, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30074534

RESUMO

BACKGROUND: Many patients receiving dabigatran treatment might also require bisoprolol therapy. However, there is a possibility that bisoprolol as significant P-glycoprotein inhibitor might interact with dabigatran. STUDY QUESTION: To investigate the impact of concomitant bisoprolol therapy on dabigatran plasma level in patients with nonvalvular atrial fibrillation. STUDY DESIGN: A pilot drug interaction study in 29 patients with nonvalvular atrial fibrillation on dabigatran therapy. Bisoprolol was administrated in 18 patients. Blood samples were collected at baseline (in the morning, before any medication was administered) and at hour 2 (2 hours after administration of dabigatran and bisoprolol). RESULTS: The dabigatran plasma level was significantly higher at baseline and at hour 2 in patients treated with bisoprolol compared with patients without bisoprolol therapy. In addition, we have shown that this increase is affected by dabigatran dosage and concomitant treatment with proton-pump inhibitor and digoxin. The impact of bisoprolol on dabigatran concentration was still significant despite these confounders. CONCLUSIONS: This study demonstrated the interaction between dabigatran and bisoprolol, which is modulated with dabigatran dosage and concomitant treatment with proton-pump inhibitor and digoxin.


Assuntos
Antagonistas Adrenérgicos beta/efeitos adversos , Antiarrítmicos/farmacocinética , Bisoprolol/efeitos adversos , Dabigatrana/farmacocinética , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/metabolismo , Bisoprolol/uso terapêutico , Cardiotônicos/efeitos adversos , Dabigatrana/uso terapêutico , Digoxina/efeitos adversos , Interações Medicamentosas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Inibidores da Bomba de Prótons/efeitos adversos
10.
J Pharm Pract ; 33(1): 96-98, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29916290

RESUMO

Beta-blockers such as metoprolol, carvedilol, and bisoprolol are indicated for the treatment of patients with reduced ejection fraction heart failure. Heart failure treatment guidelines call for titration of these medications to specific target doses for morbidity and mortality benefit. Hepatic enzymes are responsible for metabolizing these medications; however, these enzymes are subject to genetic variations (polymorphisms) that can increase or decrease enzyme activity. Metoprolol relies almost exclusively on this enzyme for degradation to inactive metabolites, whereas carvedilol relies on this enzyme only partially for metabolism, and the portion of drug that is metabolized by CYP2D6 becomes active metabolites. The clinical significance of genetic variations in CYP2D6 in heart failure patients requiring treatment with carvedilol and metoprolol remains unclear, and further research is needed before any strong recommendations on treatment approach can be made. However, based on what is known regarding the incidence of genetic variations of this enzyme, it is reasonable to conclude that heart failure patients of European and Asian ancestry may be at a greater risk of intolerance to guideline-directed doses of metoprolol. Patients of North African ancestry may be at a lower risk of intolerance to metoprolol, although limited data are available to conclude. Additionally, due to the significant prevalence of CYP2D6 enzyme variations among all ethnicities, it may be reasonable to consider switching to carvedilol for patients who are unable to fully titrate metoprolol.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Citocromo P-450 CYP2D6/genética , Variação Genética/efeitos dos fármacos , Insuficiência Cardíaca/tratamento farmacológico , Antagonistas Adrenérgicos beta/administração & dosagem , Bisoprolol/uso terapêutico , Carvedilol/uso terapêutico , Humanos , Metoprolol/uso terapêutico , Projetos de Pesquisa , Resultado do Tratamento
11.
Am J Case Rep ; 20: 1902-1906, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31857571

RESUMO

BACKGROUND Synthetic cannabinoids have a higher affinity for the cannabinoid receptors CB1 and CB2 than natural cannabinoids. Their use can be associated with cardiovascular disease and neurological complications. A case is reported of status epilepticus and stress cardiomyopathy following the recreational use of the synthetic cannabinoid, UR-144. CASE REPORT A 19-year-old woman presented to the emergency department in status epilepticus after smoking the synthetic cannabinoid known as 'space'. Recurring seizure activity was controlled after three hours. On hospital day 3, the patient developed severe biventricular failure. Cardiac magnetic resonance imaging (MRI) confirmed the diagnosis of stress cardiomyopathy. A comprehensive urine drug screen was performed using gas chromatography-mass spectrometry (GC-MS), which was positive for UR-144, or (1-pentyl-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)-methanone, and negative for all other illicit recreational drugs. The patient improved at one week following admission, with a left ventricular ejection fraction (LVEF) of 40%. She was discharged home on hospital day 10. CONCLUSIONS The use of the synthetic cannabinoid, UR-144, may be associated with prolonged status epilepticus and stress cardiomyopathy. Physicians should be aware of these potentially lethal complications associated with the recreational use of this and other illicit synthetic cannabinoids.


Assuntos
Canabinoides/efeitos adversos , Overdose de Drogas/complicações , Fumar/efeitos adversos , Estado Epiléptico/induzido quimicamente , Cardiomiopatia de Takotsubo/induzido quimicamente , Bisoprolol/uso terapêutico , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Indóis/urina , Lisinopril/uso terapêutico , Estado Epiléptico/tratamento farmacológico , Detecção do Abuso de Substâncias , Cardiomiopatia de Takotsubo/tratamento farmacológico , Adulto Jovem
12.
Sci Rep ; 9(1): 11465, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391573

RESUMO

Clinical guidelines suggest that for patients with heart failure and concurrent chronic obstructive pulmonary disease (COPD), metoprolol/bisoprolol/nebivolol should be preferred over carvedilol. However, studies suggest a high proportion of carvedilol usage that remains unexplained. Therefore, we aimed to investigate the predictors of carvedilol choice in patients with heart failure and COPD that were naïve to carvedilol or metoprolol/bisoprolol/nebivolol. Caserta Local Health Unit databases (Italy) were used as data sources. Age, sex, chronic/acute comorbidities, and co-medications were included in a logistic regression model to assess predictors of carvedilol choice. Chronic comorbidities include those defined in the Elixhauser comorbidity index and all hospitalizations within two years prior to the first beta-blocker prescription. Comedications include all redeemed prescriptions within one year prior to the beta-blocker prescription. Kernel density estimations were used to assess the overlap in propensity and preference scores distributions for receiving carvedilol and thereby potential beta-blocker exchangeability. Totally, 10091 patients composed the study population; 2011 were exposed to carvedilol. The overlapping of propensity scores distributions was 57%. Accordingly, the exchangeability was not reached. Atrioventricular block (Odds Ratio, OR 8.20; 95% Confidence Interval, 95% CI 1.30-51.80), cerebrovascular thrombosis (OR 7.06; 95% CI 1.14-43.68), chronic kidney disease (OR 4.32; 95% CI 1.16-16.02), and acute heart failure (OR 1.97; 95% CI 1.28-3.03) hospitalizations were statistically significantly associated with carvedilol choice. Analogously, human insulin (OR 3.00; 95% CI 1.24-7.24), fondaparinux (OR 2.47; 95% CI 1.17-5.21) or strontium ranelate (OR 2.03; 95% CI 1.06-3.90) redeemed prescriptions. In conclusion, this study suggests the absence of beta-blockers exchangeability and a preferential choice of carvedilol in patients with heart failure, COPD and concurrent chronic kidney disease, atrioventricular block, cerebrovascular thrombosis, acute heart failure or redeeming human insulin, fondaparinux or strontium ranelate prescriptions. Therefore, it suggests that choice of prescribing carvedilol over metoprolol/bisoprolol/nebivolol is driven by differences in comorbidities and co-treatments.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Substituição de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Insuficiência Cardíaca/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Antagonistas Adrenérgicos beta/normas , Idoso , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/epidemiologia , Bisoprolol/normas , Bisoprolol/uso terapêutico , Carvedilol/normas , Carvedilol/uso terapêutico , Transtornos Cerebrovasculares/epidemiologia , Estudos de Coortes , Comorbidade , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Substituição de Medicamentos/normas , Uso de Medicamentos/normas , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Metoprolol/normas , Metoprolol/uso terapêutico , Nebivolol/normas , Nebivolol/uso terapêutico , Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Sistema de Registros/estatística & dados numéricos , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Trombose/epidemiologia
13.
Med Arch ; 73(2): 72-75, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31391690

RESUMO

Introduction: The most appropriate choice of pharmacological treatment of heart rhythm disorders occurring in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidity is often a topic of debate between pulmonologists and cardiologists in clinical practice, although numerous studies and clinical trials have demonstrated evidence to support the use of selective beta-blockers (BBs) in these patients. Aim: To examine the difference in the number of exacerbations in patients treated with a combination of verapamil and digoxin or BB alone in patients with different COPD stages. Patients and methods: The study included 68 patients (n = 68) diagnosed with COPD who were followed-up during a 12-month period, and the number of exacerbations were analyzed. The patients were divided into two groups according to the stage of COPD: GOLD II (moderate), and GOLD III (severe), and in each group a subdivision was established in relation to the use of either a combination of verapamil and digoxin or the use of BBs alone in pharmacological treatment. The inclusion criteria for patients were defined as following: a) established diagnosis of COPD according to present or deteriorated relevant clinical symptoms and signs, b) the ejection fraction (EF) of a left ventricle (LV) >35%, and c) spirometric cut-points classified as GOLD II (FEV1 / FVC <0.7, FEV1 predicted 50-80%), or GOLD III (FEV1/FVC <0.7, FEV1 predicted 30-50%) stage of the COPD. The exclusion criteria were EF of LV <35% and a lethal outcome during a follow-up period (2 patients were encountered). Exacerbation was defined as functional deterioration of the COPD symptoms verified by spirometric functional testing, frequency of hospitalizations according to GOLD stage assignment or verified clinical symptoms deterioration. Results: Regardless the pharmacological treatment, there is a statistically significant increase in the number of COPD exacerbations, in a 12-month period follow-up, in the GOLD III group (severe) compared to the GOLD II group (moderate). In the group of patients taking verapamil and digoxin, a two-tailed t-test was used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.01, and 2. In the group of patients taking BBs, a two-tailed t-test was also used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.003). Within the COPD GOLD II stage group, there appears to be no statistically significant difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 24) and the patients taking BBs alone (n = 15), although, in patients taking BBs alone, there appears to be a trend towards a decrease in the exacerbations compared to the number of exacerbations in patients taking verapamil and digoxin (p = 0.007). Within the COPD GOLD III stage group, there is no difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 20), and the patients taking BBs alone (n = 9), as analyzed by a two-tailed t-test, p = 0.577. Conclusion: Use of selective BBs in the treatment of cardiovascular comorbidity in patients with COPD represents a far better choice of pharmacological approach in the treatment of patients diagnosed with COPD GOLD II (moderate) stage.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Arritmias Cardíacas/epidemiologia , Bisoprolol/uso terapêutico , Estudos de Casos e Controles , Digoxina/uso terapêutico , Progressão da Doença , Volume Expiratório Forçado , Humanos , Metoprolol/uso terapêutico , Nebivolol/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Índice de Gravidade de Doença , Verapamil/uso terapêutico , Capacidade Vital
14.
BMJ Case Rep ; 12(8)2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31434668

RESUMO

We present the case of a 65-year-old woman who was referred urgently from primary care with worsening breathlessness for 3 weeks, associated with tachycardia and left bundle branch block (LBBB). She had a background of type 2 diabetes, asthma and hypertension. Initial ECG revealed atrial fibrillation with the fast ventricular rate on the background of LBBB. ECHO findings were consistent with systolic impairment. Initial testing including checking thyroid function test revealed hyperthyroidism. It became evident that this patient had thyrotoxic cardiomyopathy. Early advice from the endocrine team was sought and the patient was treated with a combination of carbimazole and ivabradine. After a hospital stay, she made a remarkable recovery.


Assuntos
Bloqueio de Ramo/diagnóstico , Cardiomiopatias/diagnóstico , Anti-Hipertensivos/uso terapêutico , Bisoprolol/uso terapêutico , Bloqueio de Ramo/tratamento farmacológico , Bloqueio de Ramo/fisiopatologia , Carbimazol/uso terapêutico , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/fisiopatologia , Diabetes Mellitus Tipo 2 , Dispneia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Taquicardia , Resultado do Tratamento
15.
J Am Heart Assoc ; 8(16): e013115, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31423876

RESUMO

BackgroundThere exists a wide interindividual variability in blood pressure (BP) response to ß1-blockers. To identify the genetic determinants of this variability, we performed a pharmacogenomic genome-wide meta-analysis of genetic variants influencing ß1-blocker BP response.Methods and ResultsGenome-wide association analysis for systolic BP and diastolic BP response to ß1-blockers from 5 randomized clinical trials consisting of 1254 patients with hypertension of European ancestry were combined in meta-analysis and single nucleotide polymorphisms (SNPs) with P<10-4 were tested for replication in 2 independent randomized clinical trials of ß1-blocker-treated patients of European ancestry (n=1552). Regions harboring the replicated SNPs were validated in a ß1-blocker-treated black cohort from 2 randomized clinical trials (n=315). A missense SNP rs28404156 in BST1 was associated with systolic BP response to ß1-blockers in the discovery meta-analysis (P=9.33×10-5, ß=-3.21 mm Hg) and replicated at Bonferroni significance (P=1.85×10-4, ß=-4.86 mm Hg) in the replication meta-analysis with combined meta-analysis approaching genome-wide significance (P=2.18×10-7). This SNP in BST1 is in linkage disequilibrium with several SNPs with putative regulatory functions in nearby genes, including CD38, FBXL5, and FGFBP1, all of which have been implicated in BP regulation. SNPs in this genetic region were also associated with BP response in the black cohort.ConclusionsData from randomized clinical trials of 8 European ancestry and 2 black cohorts support the assumption that BST1 containing locus on chromosome 4 is associated with ß1-blocker BP response. Given the previous associations of this region with BP, this is a strong candidate region for future functional studies and potential use in precision medicine approaches for BP management and risk prediction.


Assuntos
ADP-Ribosil Ciclase/genética , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Antígenos CD/genética , Pressão Sanguínea , Hipertensão/tratamento farmacológico , Variantes Farmacogenômicos , Grupo com Ancestrais do Continente Africano , Atenolol/uso terapêutico , Bisoprolol/uso terapêutico , Grupo com Ancestrais do Continente Europeu , Proteínas Ligadas por GPI/genética , Estudo de Associação Genômica Ampla , Humanos , Metoprolol/uso terapêutico , Mutação de Sentido Incorreto , Farmacogenética , Polimorfismo de Nucleotídeo Único , Resultado do Tratamento
16.
Ann Noninvasive Electrocardiol ; 24(6): e12660, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31190422

RESUMO

We here report two patients with atrial flutter (AFL) and paroxysmal supraventricular tachycardia (PSVT) who were undergoing hemodialysis and returned quickly to normal sinus rhythm without hypotension when treated with bisoprolol transdermal patches (Bisono® Tape) (TOA EIYO, Tokyo, Japan). Spontaneous rhythm reversion had not occurred prior to these events in either patient. Our findings indicate that Bisono® Tape may be a new and more effective treatment for AFL and PSVT in patients undergoing hemodialysis.


Assuntos
Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Bisoprolol/uso terapêutico , Eletrocardiografia/métodos , Diálise Renal , Taquicardia Supraventricular/tratamento farmacológico , Administração Cutânea , Antagonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Idoso , Bisoprolol/administração & dosagem , Feminino , Humanos , Masculino , Taquicardia Supraventricular/diagnóstico , Adesivo Transdérmico , Resultado do Tratamento
18.
Minerva Anestesiol ; 85(9): 1038-1039, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31064169
19.
Circ J ; 83(6): 1269-1277, 2019 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-30956267

RESUMO

BACKGROUND: The comparative tolerability, efficacy, and safety of bisoprolol and carvedilol have not been established in Japanese patients with heart failure and reduced ejection fraction (HFrEF). Methods and Results: The CIBIS-J trial is a multicenter, open-label, non-inferiority randomized controlled trial of bisoprolol vs. carvedilol in 217 patients with HFrEF (EF ≤40%). The primary endpoint was tolerability, defined as reaching and maintaining the maximum maintenance dose (bisoprolol 5 mg/day or carvedilol 20 mg/day) during 48 weeks of treatment. The primary endpoint was achieved in 41.4% of patients in bisoprolol (n=111) and 42.5% in carvedilol (n=106) groups. The non-inferiority of tolerability of bisoprolol compared with carvedilol was not supported, however, neither ß-blocker was superior with regard to tolerability. Heart rate (HR) decreased in both groups and its decrease from baseline was significantly greater in the bisoprolol group (20.3 vs. 15.4 beats/min at 24 week, P<0.05). Plasma B-type natriuretic peptide (BNP) levels decreased in both groups and the decrease was significantly greater in the carvedilol group (12.4 vs. 39.0 % at 24 weeks, P<0.05). CONCLUSIONS: There were no significant differences between bisoprolol and carvedilol in the tolerability of target doses in Japanese HFrEF patients. The clinical efficacy and safety were also similar despite the greater reduction in HR by bisoprolol and plasma BNP by carvedilol.


Assuntos
Bisoprolol/uso terapêutico , Carvedilol/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Volume Sistólico , Adulto , Idoso , Idoso de 80 Anos ou mais , Bisoprolol/administração & dosagem , Carvedilol/administração & dosagem , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Japão , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Resultado do Tratamento
20.
Hypertens Res ; 42(4): 496-503, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30948819

RESUMO

Although beta blockers have been used as initial therapy for ischemic heart diseases and heart failure, the beneficial effects of beta blockers are controversial compared with other antihypertensive agents as initial therapy for hypertension without compelling indications. Moreover, atenolol has been most commonly used with beta blockers. The objective of the present systematic review associated with the Japanese Society of Hypertension (JSH) 2019 Hypertension Guideline (Clinical Question 6) was to assess the outcomes (cardiocerebrovascular mortality, total cause mortality, hypotension, bradycardia, other adverse effects, and changes in systolic blood pressure (SBP)) of currently used carvedilol and bisoprolol as initial therapy for adult hypertension without compelling indications. Two independent systematic reviewers searched randomized controlled trials (RCTs) up to October 2017 in the Cochrane Hypertension Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, EMBASE Ovid, and ClinicalTrials.gov. Finally, eight RCTs with 2494 participants were identified to meet our inclusion criteria. There were no RCTs in which cardiocerebrovascular mortality, total cause mortality, hypotension, and bradycardia were assessed between carvedilol or bisoprolol and placebo. SBP-lowering effects were significantly increased for bisoprolol compared with placebo. Here, 50 mg carvedilol significantly reduced SBP compared with placebo, whereas 12.5 mg or 25 mg did not. Regarding adverse effects, no differences were noted between carvedilol and placebo (two RCTs, 286 participants, moderate certainly evidence). In conclusion, current evidence does not support carvedilol or bisoprolol as first-line therapy for adult hypertension without compelling indications.


Assuntos
Anti-Hipertensivos/uso terapêutico , Bisoprolol/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Carvedilol/uso terapêutico , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/farmacologia , Bisoprolol/farmacologia , Carvedilol/farmacologia , Humanos , Resultado do Tratamento
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