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1.
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
2.
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
3.
A A Pract ; 13(3): 99-101, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30907753

RESUMO

Spontaneous coronary artery disease is an uncommon and likely underdiagnosed cause of sudden cardiac death affecting typically young and middle-aged women. We report a case of spontaneous coronary artery disease in the postoperative period in a female patient who developed an acute coronary event after gynecologic surgery. The patient was clinically asymptomatic except for mild hemodynamic instability and ST-segment-elevation myocardial infarction seen on electrocardiogram. Spontaneous coronary artery disease was diagnosed with coronary angiography, and a pharmacological therapy was instituted with favorable results.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Doenças Vasculares/congênito , Adulto , Aspirina/uso terapêutico , Bisoprolol/uso terapêutico , Clopidogrel/uso terapêutico , Angiografia Coronária , Anomalias dos Vasos Coronários/tratamento farmacológico , Feminino , Heparina/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Histerectomia Vaginal , Período Pós-Operatório , Doenças Vasculares/diagnóstico , Doenças Vasculares/tratamento farmacológico
4.
Front Biosci (Landmark Ed) ; 24: 1037-1049, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30844728

RESUMO

An autoimmune reaction directed against the cardiac b1-adrenergic receptor (beta1-ADR) leading to the generation of autoantibodies (AA) against this G-coupled receptor has been described in patients with heart failure (HF). Agonist-like beta1-ADR-AA are associated with morbidity in HF patients and even predict mortality. Standardised and valid diagnostic tools to detect beta 1-ADR-AA in clinical routine are lacking. We used a novel ELISA approach to investigate beta 1-ADR-AA in a cohort of 574 HF patients of the CIBIS-ELD trial with follow up. The CIBIS-ELD trial compared the titration of bisoprolol and carvedilol to recommended target doses in regard to BB tolerability in patients aged 65 years and older. Patient with left ventricular (LV) ejection fraction (EF) less than 50% or LV diameter end diastolic (DED) more than 55 cm showed significantly higher levels of beta1-ADR-AA. Although not yet fully validated, this ELISA allowed for a negative correlation of beta1-ADR-AA with the EF at baseline and at the follow up, beta1-ADR-AA further correlated positively with basal heart rate at follow up 12 weeks later. beta1-ADR-AA levels thus determined  significantly increased under titration with beta-blockers (pless  than 0.01). Changes in beta1-ADR-AA between F-Up and baseline were significantly higher in patients who used beta blockers (p=0.016) before study inclusion. The type of beta-blocker titrated in this study did not affect log beta1-ADR-AA levels at baseline (p=0.132), follow-up (p=0.058), nor the change (p=0.426). beta1-ADR-AA levels were estimated using a novel, commercially available ELISA. Although not yet fully validated, this ELISA allowed for pathophysiological insights: beta1-ADR-AA levels thus determined significantly increased under titration with beta-blockers (pless  than 0.01), irrespective of type of BB. Higher levels of beta1-ADR-AA at baseline are associated with higher heart rates, lower ejection fraction and enlarged left ventricles. The relevance of the beta1-ADR-AA biomarker should be further evaluated.


Assuntos
Autoanticorpos/sangue , Insuficiência Cardíaca/imunologia , Receptores Adrenérgicos beta 1/imunologia , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Bisoprolol/uso terapêutico , Carvedilol/uso terapêutico , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Taxa de Filtração Glomerular , Insuficiência Cardíaca/tratamento farmacológico , Frequência Cardíaca , Humanos , Masculino , Resultado do Tratamento , Função Ventricular Esquerda
5.
J Med Case Rep ; 13(1): 22, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30678717

RESUMO

INTRODUCTION: Simultaneous occurrence of transient global amnesia and Takotsubo syndrome has been only rarely reported. Here we report another patient with a transient global amnesia and concomitant Takotsubo syndrome. CASE PRESENTATION: Our patient is a 64-year-old white man with a previous history of myocarditis from borreliosis who developed sudden-onset confusional state with perseverations and repetition of the same questions during a funeral for his brother-in-law. Upon neurological work-up and after spontaneous resolution of most of the neurological deficits, transient global amnesia was diagnosed. Blood tests revealed moderate renal insufficiency, elevated troponin-T, and elevated N-terminal prohormone of brain natriuretic peptide. Electrocardiography showed left anterior hemiblock and negative T-waves in V2-V6. Upon transthoracic echocardiography the apical type of a Takotsubo syndrome was suspected. Since coronary angiography was normal and electrocardiography and echocardiographic abnormalities resolved under candesartan, bisoprolol, acetyl-salicylic acid, and atorvastatin within a few days after onset, Takotsubo syndrome was diagnosed. CONCLUSIONS: Since Takotsubo syndrome may be associated with transient global amnesia a causal relation may exist. A possible trigger for both conditions could be severe emotional stress from the loss of a close relative. A possible common pathomechanism could be overstimulation of adrenergic receptors in the myocardium, the cerebrum, or the coronary or cerebral arteries. Whether pre-existing myocardial compromise promotes the development of Takotsubo syndrome requires further investigations.


Assuntos
Amnésia Global Transitória/fisiopatologia , Hipertensão/fisiopatologia , Miocardite/fisiopatologia , Estresse Psicológico/fisiopatologia , Cardiomiopatia de Takotsubo/fisiopatologia , Amnésia Global Transitória/tratamento farmacológico , Amnésia Global Transitória/etiologia , Amnésia Global Transitória/psicologia , Anti-Hipertensivos/uso terapêutico , Aspirina/uso terapêutico , Atorvastatina/uso terapêutico , Benzimidazóis/uso terapêutico , Bisoprolol/uso terapêutico , Angiografia Coronária , Eletrocardiografia , Fibrinolíticos/uso terapêutico , Pesar , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/psicologia , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/psicologia , Tetrazóis/uso terapêutico , Resultado do Tratamento
6.
Curr Drug Saf ; 14(1): 27-30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30370856

RESUMO

BACKGROUND: Cardioselective beta-blockers may affect glucose or lipid profiles. OBJECTIVE: We sought to compare the effects of two beta-blockers, metoprolol and bisoprolol, as the most commonly used drugs in cardiology, on glucose and lipid profiles in patients with cardiovascular diseases. METHODS: We conducted a retrospective cross-sectional matched study at Prince Sultan Cardiac Center in Burydah in August 2017. Patient records were screened, and adult patients with cardiovascular disorders who were treated with a stable dose of metoprolol or bisoprolol were included. Parameters related to glucose and lipid metabolism were compared using the Student's t-test between the two groups. RESULTS AND CONCLUSION: The metoprolol and bisoprolol arms included 204 and 200 patients, respectively.


Assuntos
Bisoprolol/uso terapêutico , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/tratamento farmacológico , Glucose/metabolismo , Lipídeos/sangue , Metoprolol/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Bisoprolol/efeitos adversos , Estudos Transversais , Eletrocardiografia/efeitos dos fármacos , Feminino , Humanos , Masculino , Metoprolol/efeitos adversos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
Intern Med ; 58(4): 535-539, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30333393

RESUMO

Midventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare form of hypertrophic cardiomyopathy (HCM). An 80-year-old man was administered bisoprolol and warfarin therapies as treatment for MVOHCM with an apex aneurysm due to myocardial damage and intra-aneurysmal thrombus not complicated by atrial fibrillation. The pressure gradient in the midventricle successfully improved from 53.9 to 21.8 mmHg, and the intra-aneurysmal thrombus disappeared.


Assuntos
Anticoagulantes/uso terapêutico , Bisoprolol/uso terapêutico , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/tratamento farmacológico , Aneurisma Cardíaco/complicações , Pressão Ventricular/efeitos dos fármacos , Varfarina/uso terapêutico , Idoso de 80 Anos ou mais , Humanos , Masculino , Resultado do Tratamento
8.
Pharmacol Res ; 139: 106-112, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30408572

RESUMO

A cohort analysis using UK Clinical Practice Research Datalink (CPRD) was performed to compare the effects of bisoprolol, other ß-blockers, and drugs other than ß-blockers on the long-term risk of mortality and cardiovascular events in patients with angina. Adult patients first diagnosed with angina from 2000 to 2014, with ≥365 days of registration to first angina diagnosis and initiating monotherapies of bisoprolol, other ß-blockers, or drugs other than ß-blockers within 6 months of angina diagnosis were included. Incidence rates for each treatment cohort were compared using adjusted hazard ratio (HR) and 95% confidence intervals (CI) obtained from Cox regression analyses. Overall, 987 patients were treated with bisoprolol, 1348 with other ß-blockers and 5272 with drugs other than ß-blockers. Over the total follow-up (≤14 years), the HR of bisoprolol versus other ß-blockers and drugs other than ß-blockers for mortality was 0.45 (95% CI: 0.34-0.61) and 0.50 (95% CI: 0.38-0.66), respectively. The HR of bisoprolol versus other ß-blockers for angina was 0.58 (95% CI: 0.50-0.68) and versus drugs other than ß-blockers was 0.77 (95% CI: 0.68-0.88), respectively. For myocardial infarction, the HR of bisoprolol versus drugs other than ß-blockers up to 14 years was 0.34 (95% CI: 0.23-0.52) and versus other ß-blockers up to 5 years was 0.45 (95% CI: 0.27-0.75). At 5 years, the HR of bisoprolol versus other ß-blockers, and drugs other than ß-blockers, for arrhythmia was 0.60 (95% CI: 0.35-1.0) and 0.61 (95% CI: 0.40-0.93), respectively. In conclusion, long-term significant reduction in the risk of mortality and various cardiovascular events with bisoprolol versus other ß-blockers, and drugs other than ß-blockers, confirm treatment guidelines recommendation that bisoprolol is particularly well suited as the first-line treatment of angina in primary care.


Assuntos
Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Angina Pectoris/tratamento farmacológico , Bisoprolol/uso terapêutico , Adolescente , Adulto , Idoso , Angina Pectoris/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
10.
J Hypertens ; 36(10): 2109-2117, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29985206

RESUMO

OBJECTIVES: Beta-blockers are frequently used during pregnancy, with labetalol and metoprolol being considered as drugs of choice. As there are no prospective pregnancy studies for bisoprolol yet, our aim was to analyze pregnancy outcomes after bisoprolol exposure. METHODS: Pregnancies exposed to bisoprolol during the first trimester were retrieved from the German Embryotox pharmacovigilance database. Pregnancy outcomes of prospectively ascertained pregnancies were compared with women neither exposed to beta-blockers nor other antihypertensives. In addition, retrospective reports on adverse drug reactions were screened for patterns of birth defects. RESULTS: Inclusion criteria for the prospective study were met by 339 bisoprolol-treated women and 678 patients in the comparison cohort. Neither the risk for spontaneous abortions [adjusted hazard ratio (HRadj.) 1.06; 95% confidence interval (CI) 0.66-1.70] nor for major congenital malformations [adjusted odds ratio (ORadj.) 0.77; 95% CI 0.34-1.75] was increased after first trimester bisoprolol treatment. However, higher rates of preterm births [ORadj. 1.90; 95% CI 1.17-3.11] and reduced birthweights in singleton pregnancies (adjusted standard deviation score difference -0.48; 95% CI -0.62 to -0.34) were noted. Continued treatment with beta-blockers until birth was found to be associated with a higher risk for growth restriction than first trimester exposure only. A sensitivity analysis did not suggest higher rates of adverse pregnancy outcomes in hypertensive women on bisoprolol compared with nonhypertensive bisoprolol-exposed women. CONCLUSION: Our study supports the hypothesis that first trimester bisoprolol treatment does not increase the risk for spontaneous abortions or major birth defects. However, an influence of prolonged bisoprolol exposure on fetal growth cannot be ruled out.


Assuntos
Aborto Espontâneo/epidemiologia , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Bisoprolol/uso terapêutico , Aborto Espontâneo/etiologia , Adolescente , Antagonistas de Receptores Adrenérgicos beta 1/efeitos adversos , Adulto , Peso ao Nascer , Bisoprolol/efeitos adversos , Estudos de Casos e Controles , Estudos de Coortes , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/etiologia , Feminino , Alemanha/epidemiologia , Humanos , Hipertensão/tratamento farmacológico , Recém-Nascido , Pessoa de Meia-Idade , Razão de Chances , Farmacovigilância , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Modelos de Riscos Proporcionais , Estudos Prospectivos , Estudos Retrospectivos , Adulto Jovem
11.
J Pharm Biomed Anal ; 159: 272-281, 2018 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-30005242

RESUMO

Cardiovascular disease is a leading cause of morbidity, mortality, and healthcare expenditure worldwide. Importantly, there is interindividual variation in response to cardiovascular medications, leading to variable efficacy and adverse events. Therefore a rapid, selective, sensitive and reproducible multi-analyte HPLC-MS/MS assay for the quantification in human plasma of atorvastatin, its major metabolites 2-hydroxyatorvastatin, atorvastatin lactone and 2-hydroxyatorvastatin lactone, plus bisoprolol and clopidogrel-carboxylic acid has been developed, fully validated, and applied to a large patient study. Fifty microliter plasma samples were extracted with a simple protein precipitation procedure involving acetonitrile with acetic acid (0.1%, v/v). Chromatographic separation was via a 2.7 µm Halo C18 (50 × 2.1 mm ID, 90 Å) column and gradient elution at a flow rate of 500 µL/min consisting of a mobile phase of water (A) and acetonitrile (B), each containing 0.1% formic acid (v/v), over a 6.0 min run time. The six analytes and their corresponding six deuterated internal standards underwent positive ion electrospray ionisation and were detected with multiple reaction monitoring. The developed method was fully validated with acceptable selectivity, carryover, dilution integrity, and within-run and between-run accuracy and precision. Mean extraction recovery for the analytes was 92.7-108.5%, and internal standard-normalised matrix effects had acceptable precision (coefficients of variation 2.2-12.3%). Moreover, all analytes were stable under the tested conditions. Atorvastatin lactone to acid interconversion was assessed and recommendations for its minimisation are made. The validated assay was successfully applied to analyse 1279 samples from 1024 patients recruited to a cardiovascular secondary prevention prospective study.


Assuntos
Atorvastatina/sangue , Bisoprolol/sangue , Doenças Cardiovasculares/sangue , Espectrometria de Massas em Tandem/normas , Ticlopidina/análogos & derivados , Anticolesterolemiantes/sangue , Anticolesterolemiantes/uso terapêutico , Anti-Hipertensivos/sangue , Anti-Hipertensivos/uso terapêutico , Atorvastatina/uso terapêutico , Bisoprolol/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Cromatografia Líquida de Alta Pressão/normas , Cromatografia Líquida de Alta Pressão/tendências , Clopidogrel , Estudos de Coortes , Feminino , Humanos , Masculino , Espectrometria de Massas/normas , Espectrometria de Massas/tendências , Inibidores da Agregação de Plaquetas/sangue , Inibidores da Agregação de Plaquetas/uso terapêutico , Estudos Prospectivos , Reprodutibilidade dos Testes , Espectrometria de Massas em Tandem/tendências , Ticlopidina/sangue , Ticlopidina/uso terapêutico
12.
Emerg Med J ; 35(9): 559-563, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29921621

RESUMO

OBJECTIVES: Beta blockers (ß-blockers) remain a standard therapy in the early treatment of acute coronary syndromes. However, ß-blocker therapy in patients with cocaine-associated chest pain (CACP) continues to be an area of debate due to the potential risk of unopposed α-adrenergic stimulation and coronary vasospasm. Therefore, we performed a systematic review and meta-analysis of available studies to compare outcomes of ß-blocker versus no ß-blocker use among patients with CACP. METHODS: We searched the MEDLINE and EMBASE databases through September 2016 using the keywords 'beta blocker', 'cocaine' and commonly used ß-blockers ('atenolol', 'bisoprolol', 'carvedilol', 'esmolol', 'metoprolol' and 'propranolol') to identify studies evaluating ß-blocker use among patients with CACP. We specifically focused on studies comparing outcomes between ß-blocker versus no ß-blocker usage in patients with CACP. Studies without a comparison between ß-blocker and no ß-blocker use were excluded. Outcomes of interest included non-fatal myocardial infarction (MI) and all-cause mortality. Quantitative data synthesis was performed using a random-effects model and heterogeneity was assessed using Q and I2statistics. RESULTS: A total of five studies evaluating 1794 subjects were included. Overall, there was no significant difference on MI in patients with CACP on ß-blocker versus no ß-blocker (OR 1.36, 95% CI 0.68 to 2.75; p=0.39). Similarly, there was no significant difference in all-cause mortality in patients on ß-blocker versus no ß-blocker (OR 0.68, 95% CI 0.26 to 1.79; p=0.43). CONCLUSIONS: In patients presenting with acute chest pain and underlying cocaine, ß-blocker use does not appear to be associated with an increased risk of MI or all-cause mortality.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Antagonistas Adrenérgicos beta/farmacologia , Cocaína/efeitos adversos , Síndrome Coronariana Aguda/etiologia , Antagonistas Adrenérgicos beta/uso terapêutico , Atenolol/farmacologia , Atenolol/uso terapêutico , Bisoprolol/farmacologia , Bisoprolol/uso terapêutico , Carvedilol/farmacologia , Carvedilol/uso terapêutico , Humanos , Metoprolol/farmacologia , Metoprolol/uso terapêutico , Propanolaminas/farmacologia , Propanolaminas/uso terapêutico , Propranolol/farmacologia , Propranolol/uso terapêutico
13.
J Korean Med Sci ; 33(25): e171, 2018 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-29915522

RESUMO

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.


Assuntos
Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Bisoprolol/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Remodelação Ventricular/fisiologia , Antagonistas de Receptores Adrenérgicos beta 1/farmacologia , Adulto , Fatores Etários , Idoso , Bisoprolol/farmacologia , Feminino , Insuficiência Cardíaca/patologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/análise , Razão de Chances , Fragmentos de Peptídeos/análise , Estudos Prospectivos , Função Ventricular Esquerda/efeitos dos fármacos
14.
Kardiologiia ; (3): 63-72, 2018 Mar.
Artigo em Russo | MEDLINE | ID: mdl-29782273

RESUMO

The article discusses various mechanisms of developmentt and progression of arterial hypertension in young and middle aged adults. It emphasizes the predominant role of hypersympathicotonia in the development of the disease in this category of patients. Various mechanisms are considered, by means of which the increase of activity of the sympathetic nervous system leads to elevation of arterial pressure and potentiates early damage of target organs, first of all, damage of the heart. The data of numerous studies demonstrating pronounced cardioprotective effects of a highly selective representative of the class of ß-blockers bisoprolol in young and middle aged hypertensive patients are presented.


Assuntos
Bisoprolol/uso terapêutico , Hipertensão Essencial/tratamento farmacológico , Antagonistas Adrenérgicos beta , Humanos , Pessoa de Meia-Idade , Sistema Nervoso Simpático
15.
Int J Clin Pharmacol Ther ; 56(9): 393-399, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29809132

RESUMO

INTRODUCTION: Cardiovascular disease is the leading global cause of death. Its development is largely determined by lifestyle and cardiovascular risk factors, among which arterial hypertension (HT) plays a key role. Available data indicate a significant role of inflammation in the pathophysiology of HT. OBJECTIVES: The aim of this study was to assess concentrations of mediators of inflammation in patients with mild and moderate HT and its modulation with antihypertensive treatment. MATERIALS AND METHODS: 56 subjects: 17 with first- and 20 with second-grade HT, and 19 healthy subjects constituting a control group. Antihypertensive therapy: in first-grade HT, perindopril 5 mg daily, and in second-grade HT, bisoprolol (5 mg daily) additionally were ordered. Before and after a 4-week treatment, interleukine-2, interferon-γ, and high-sensitivity C-reactive protein serum concentrations were assessed. RESULTS: hs-CRP concentration was higher in hypertensive patients, and the difference was statistically significant in patients with second-grade HT compared to the control group (1.42 mg/L vs. 2.55 mg/L; p = 0.003). Antihypertensive treatment was associated with hs-CRP decrease. IL-2 concentration was 14.8% (p = 0.005) higher in first- and 22.2% (p = 0.002) higher in second-grade HT compared to the controls. Treatment significantly reduced concentration of IL-2. IFN-γ concentrations, compared to the control group, were higher by 19.6% (p < 0.001) and 39.9% (p < 0.001) in 1st and 2nd grade HT, respectively. CONCLUSION: Increased values of blood pressure were accompanied by higher concentrations of cytokines and hs-CRP. Reversal of adverse T-cell stimulation was observed after 4-week therapy.
.


Assuntos
Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , Bisoprolol/uso terapêutico , Proteína C-Reativa/metabolismo , Hipertensão/tratamento farmacológico , Interferon gama/sangue , Interleucina-2/sangue , Ativação Linfocitária/efeitos dos fármacos , Perindopril/uso terapêutico , Linfócitos T/efeitos dos fármacos , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão/sangue , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Linfócitos T/imunologia , Linfócitos T/metabolismo , Fatores de Tempo , Resultado do Tratamento
16.
Lancet Diabetes Endocrinol ; 6(6): 464-475, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29655877

RESUMO

BACKGROUND: In the PATHWAY-2 study of resistant hypertension, spironolactone reduced blood pressure substantially more than conventional antihypertensive drugs. We did three substudies to assess the mechanisms underlying this superiority and the pathogenesis of resistant hypertension. METHODS: PATHWAY-2 was a randomised, double-blind crossover trial done at 14 UK primary and secondary care sites in 314 patients with resistant hypertension. Patients were given 12 weeks of once daily treatment with each of placebo, spironolactone 25-50 mg, bisoprolol 5-10 mg, and doxazosin 4-8 mg and the change in home systolic blood pressure was assessed as the primary outcome. In our three substudies, we assessed plasma aldosterone, renin, and aldosterone-to-renin ratio (ARR) as predictors of home systolic blood pressure, and estimated prevalence of primary aldosteronism (substudy 1); assessed the effects of each drug in terms of thoracic fluid index, cardiac index, stroke index, and systemic vascular resistance at seven sites with haemodynamic monitoring facilities (substudy 2); and assessed the effect of amiloride 10-20 mg once daily on clinic systolic blood pressure during an optional 6-12 week open-label runout phase (substudy 3). The PATHWAY-2 trial is registered with EudraCT, number 2008-007149-30, and ClinicalTrials.gov, number NCT02369081. FINDINGS: Of the 314 patients in PATHWAY-2, 269 participated in one or more of the three substudies: 126 in substudy 1, 226 in substudy 2, and 146 in substudy 3. Home systolic blood pressure reduction by spironolactone was predicted by ARR (r2=0·13, p<0·0001) and plasma renin (r2=0·11, p=0·00024). 42 patients had low renin concentrations (predefined as the lowest tertile of plasma renin), of which 31 had a plasma aldosterone concentration greater than the mean value for all 126 patients (250 pmol/L). Thus, 31 (25% [95% CI 17-33]) of 126 patients were deemed to have inappropriately high aldosterone concentrations. Thoracic fluid content was reduced by 6·8% from baseline (95% CI 4·0 to 8·8; p<0·0001) with spironolactone, but not other treatments. Amiloride (10 mg once daily) reduced clinic systolic blood pressure by 20·4 mm Hg (95% CI 18·3-22·5), compared with a reduction of 18·3 mm Hg (16·2-20·5) with spironolactone (25 mg once daily). No serious adverse events were recorded, and adverse symptoms were not systematically recorded after the end of the double-blind treatment. Mean plasma potassium concentrations increased from 4·02 mmol/L (95% CI 3·95-4·08) on placebo to 4·50 (4·44-4·57) on amiloride (p<0·0001). INTERPRETATION: Our results suggest that resistant hypertension is commonly a salt-retaining state, most likely due to inappropriate aldosterone secretion. Mineralocorticoid receptor blockade by spironolactone overcomes the salt retention and resistance of hypertension to treatment. Amiloride seems to be as effective an antihypertensive as spironolactone, offering a substitute treatment for resistant hypertension. FUNDING: British Heart Foundation and UK National Institute for Health Research.


Assuntos
Anti-Hipertensivos/uso terapêutico , Bisoprolol/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Doxazossina/uso terapêutico , Hipertensão/tratamento farmacológico , Espironolactona/uso terapêutico , Aldosterona/metabolismo , Amilorida/uso terapêutico , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Schizophr Res ; 199: 403-406, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29602642

RESUMO

Tachycardia is associated with cardiovascular mortality. Tachycardia is also a known clozapine adverse effect. However, whether clozapine-associated tachycardia is persistent is not known. Thirty clozapine-treated patients with clinical tachycardia were investigated with 24-hour ambulatory electrocardiography (ECG). Baseline peripheral heart rate (HR) was 106.7±7.8. The ambulatory ECG 24-hour-HR was 98.7±9.7. Baseline HR and 24-hour-HR correlated strongly (r=0.74, p=0.000003). Daytime HR was 106.4±9.9 and nighttime HR 89.2±12.0. Low dose bisoprolol reduced HR significantly. The high 24-hour-HR indicates a persistent tachycardia. Tachycardia should not discourage from clozapine use but the findings indicate a need of guidelines for detection and treatment of clozapine-associated tachycardia.


Assuntos
Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Frequência Cardíaca/efeitos dos fármacos , Taquicardia/etiologia , Adulto , Antipsicóticos/uso terapêutico , Bisoprolol/uso terapêutico , Fármacos Cardiovasculares/uso terapêutico , Clozapina/uso terapêutico , Eletrocardiografia Ambulatorial , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Fotoperíodo , Taquicardia/diagnóstico , Taquicardia/tratamento farmacológico , Taquicardia/fisiopatologia , Fatores de Tempo
18.
J Hypertens ; 36(7): 1563-1570, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29601411

RESUMO

BACKGROUND AND AIM: Treatment-resistant hypertension (TRH) is associated with particular clinical features, nonadherence, and suboptimal treatment. We assessed possible associations of antihypertensive drug classes, specific agents inside each class, and types of combinations, with the presence of non-TRH vs. TRH, and with controlled vs. uncontrolled TRH. METHODS: Comparisons were done in 14 264 patients treated with three drugs (non-TRH: 2988; TRH: 11 276) and in 6974 treated with at least four drugs (controlled TRH: 1383; uncontrolled TRH: 5591). Associations were adjusted for age, sex, and previous cardiovascular event. RESULTS: In both groups of patients treated with three or with at least four drugs, aldosterone antagonists among drug classes [adjusted odds ratio (OR): 1.82 and 1.41, respectively], and ramipril (OR: 1.28 and 1.30), olmesartan (OR: 1.31 and 1.37), and amlodipine (OR: 1.11 and 1.41) inside each class were significantly associated with blood pressure control (non-TRH or controlled TRH). In patients treated with three drugs, non-TRH was also associated with the use of chlorthalidone (OR: 1.50) and bisoprolol (OR: 1.19), whereas in patients treated with at least four drugs, controlled TRH was significantly associated with the triple combination of a renin-angiotensin system blocker, a calcium channel blocker, and a diuretic (OR: 1.17). CONCLUSION: The use of aldosterone antagonists is associated with blood pressure control in patients treated with three or more drugs. Similar results are observed with specific agents inside each class, being ramipril, olmesartan, chlorthalidone, amlodipine, and bisoprolol those exhibiting significant results. An increased use of these drugs might probably reduce the burden of TRH.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Anlodipino/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Bisoprolol/uso terapêutico , Pressão Sanguínea , Bloqueadores dos Canais de Cálcio/uso terapêutico , Clortalidona/uso terapêutico , Diuréticos/uso terapêutico , Resistência a Medicamentos , Quimioterapia Combinada , Humanos , Hipertensão/fisiopatologia , Imidazóis/uso terapêutico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Ramipril/uso terapêutico , Tetrazóis/uso terapêutico
19.
Curr Med Res Opin ; 34(11): 1921-1926, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29557206

RESUMO

OBJECTIVE: We evaluated change in resting heart rate (RHR) and its impact on prognosis in Chinese coronary artery disease (CAD) patients treated with bisoprolol, and also assessed drug safety and tolerability. METHODS: This phase IV, single arm observational study was a sub-study of the BISO-CAD study conducted across 20 hospitals in China between October 2011 and July 2015 with follow-up at 6, 12 and 18 months after baseline. The primary endpoint was occurrence of composite cardiac events. RESULTS: A total of 663 CAD patients (baseline RHR 75.47 ± 6.62 bpm) were enrolled in the intent-to-treat (ITT) set, and 513 patients were included in the efficacy analysis (EA) set. In the ITT set, the risk and the number of composite cardiac events in patients with mean RHR 69-74 bpm were significantly higher than in the <65 bpm group (ITT: estimate 1.03 ± 0.47, p = .029). The incidence of the composite cardiac endpoint was not affected by continuous mean RHR (p = .5070). RHR significantly decreased from baseline to 18 months, most obviously in the first 6 months (p < .0001). Ejection fraction and fractional shortening significantly improved in both the ITT and EA sets. An average RHR of 69-74 bpm had a significant effect on admission to hospital for acute coronary syndrome in the ITT (estimate 1.10, HR 3.004, p = .0196) and EA (estimate 1.26, HR 3.526, p = .0132) groups. Seven (1.1%) patients reported drug related adverse events. CONCLUSION: Reduction in RHR with bisoprolol lowered the incidence of composite cardiac events along with an acceptable safety and tolerability profile.


Assuntos
Síndrome Coronariana Aguda , Bisoprolol/uso terapêutico , Doença da Artéria Coronariana , Frequência Cardíaca/efeitos dos fármacos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/prevenção & controle , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Idoso , China/epidemiologia , Estudos de Coortes , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Resultado do Tratamento
20.
J Med Case Rep ; 12(1): 76, 2018 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-29562910

RESUMO

BACKGROUND: Stroke is a recognized clinical course of hypertrophic cardiomyopathy. This interesting case showed notable difference on the electrocardiogram of a patient 4 months prior to suffering a stroke and 10 days after suffering a stroke. The pre-stroke electrocardiogram showed atrial fibrillation with a narrow QRS complex, while the post-stroke electrocardiogram showed marked left ventricular hypertrophy. Left ventricular hypertrophy was diagnosed using the Sokolow-Lyon indices. The development of left ventricular hypertrophy a few days after suffering a stroke has not previously been reported. CASE PRESENTATION: An 83-year-old white British woman with a background history of permanent atrial fibrillation, hypertension, and previous stroke attended the emergency department with a 2-day history of exertional dyspnea, and chest tightness. On examination, she had bibasal crepitations with a systolic murmur loudest at the apex. In-patient investigations include an electrocardiogram, blood tests, chest X-ray, contrast echocardiogram, coronary angiogram, and cardiovascular magnetic resonance imaging. An electrocardiogram showed atrial fibrillation, with inferolateral T wave inversion, and left ventricular hypertrophy. A chest X-ray showed features consistent with pulmonary edema. A contrast echocardiogram showed marked hypertrophy of the mid to apical left ventricle, appearance consistent with apical hypertrophic cardiomyopathy. Coronary angiography showed eccentric shelf-type plaque with non-flow-limiting stenosis in the left coronary artery main stem. Cardiovascular magnetic resonance imaging reported findings highly suggestive of apical hypertrophic cardiomyopathy. Our patient was treated and discharged on rivaroxaban, bisoprolol, and atorvastatin with a follow-up in the cardiomyopathy outpatient clinic. CONCLUSIONS: Electrocardiogram diagnosis of left ventricular hypertrophy led to the diagnosis of apical hypertrophic cardiomyopathy in this patient. Left ventricular hypertrophy was only evident a few days after our patient suffered a stroke. The underlying mechanisms responsible for this remain unclear. Furthermore, differential diagnosis of hypertrophic cardiomyopathy should be considered in people with electrocardiogram criteria for left ventricular hypertrophy. Cardiovascular magnetic resonance imaging is an important diagnostic tool in identifying causes of left ventricular hypertrophy. Family screening should be recommended in patients with new diagnosis of hypertrophic cardiomyopathy.


Assuntos
Anti-Hipertensivos/uso terapêutico , Bisoprolol/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/diagnóstico , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/complicações , Idoso de 80 Anos ou mais , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/fisiopatologia , Dor no Peito , Angiografia Coronária , Diagnóstico Diferencial , Dispneia , Eletrocardiografia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/genética , Hipertrofia Ventricular Esquerda/fisiopatologia , Imagem por Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
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