Are we misunderstanding beta-blockers

Cruickshank, J. M.

doi:10.1016/j.ijcard.2007.01.069

Cited by 95 publications

(92 citation statements)

References 190 publications

(202 reference statements)

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“…methyldopa, clonidine, guanabenz, and guanfacine, (b) blocking acetylcholine from stimulating the postganglionic autonomic stimulating the release of NO (Cruickshank, 2007;Cheng, 2009;Weir, 2009;Benowitz, 2011;Trevor et al, 2011).…”

Section: Drugs That Alter Sympathetic Nervous System Functionmentioning

confidence: 99%

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Effect of Tulbaghia violacea on the blood pressure and heart rate in male spontaneously hypertensive Wistar rats

Raji

Mugabo

Obikeze

2012

Journal of Ethnopharmacology

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Effect of Tulbaghia violacea on the blood pressure and heart rate in male spontaneously hypertensive Wistar rats I. A. RAJITulbaghia violacea Harv. (Alliaceae) is a small bulbous herb which belongs to the family, Alliaceae, most commonly associated with onions and garlic. In South Africa (SA), this herb has been traditionally used in the treatment of various ailments, including fever, colds, asthma, paralysis, hypertension (HTN) and stomach problems. The aim of this study was to evaluate the effect of methanol leaf extracts (MLE) of T. violacea on the blood pressure (BP) and heart rate (HR) in anaesthetized male spontaneously hypertensive rats; and to find out the mechanism(s) by which it acts.The MLE of T. violacea (5 -150 mg/kg), angiotensin I (ang I, 3.1 -100 µg/kg), captopril (10 mg/kg), angiotensin II (ang II, 3.1 -50 µg/kg), losartan (30 mg/kg), phenylephrine T. violacea (60 mg/kg) and captopril (10 mg/kg) were injected intraperitoneally into iii some SHR for 21 days to investigate the chronic effect of these agents on plasma levels of aldosterone. The mean change, the mean of the individual percentage changes and the percentage difference (in mean) observed with each intervention was calculated and statistically analyzed using the Student's t test for significant difference (p < 0.05). The Microsoft Excel software was used for statistical analysis.T. violacea significantly (p < 0.05) reduced the systolic, diastolic, and mean arterial BP;and HR dose-dependently. In a dose-dependent manner, ang I, ang II, phenylephrine significantly (p < 0.05) increased the BP, while propranolol, muscarine and atropine reduced the BP. The increases in BP due to dobutamine were not dose-dependent. In a dose dependent manner, phenylephrine and propranolol reduced the HR, while dobutamine increased the HR. The effect of ang I, ang II, muscarine and atropine on HR were not dose-dependent; with both increases as well as decreases observed with ang I, and II and atropine, while decreases were seen with muscarine. Captopril produced significant (p < 0.05) reduction in BP which were not associated with any change in HR.The co-infusion of ang I with the MLE produced significant (p < 0.05) reduction in BP, which were not associated with significant changes in HR. The co-infusion of ang II with the MLE did not produce any significant changes in BP or HR when compared to the infusion of the standard drug alone. The co-infusion of phenylephrine with the MLE did

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Section: Drugs That Alter Sympathetic Nervous System Functionmentioning

confidence: 99%

“…33). Although both subtypes of the β receptor present in the heart are excitatory and their stimulation leads to an increase in cardiac output, the β 1 receptors are the primary adrenergic receptors in the heart (Freeman et al, 2006;Cruickshank, 2007;McCorry, 2007).…”

Section: Does T Violacea Act By Blocking the Beta I Adrenoceptors?mentioning

confidence: 99%

Effect of Tulbaghia violacea on the blood pressure and heart rate in male spontaneously hypertensive Wistar rats

Raji

Mugabo

Obikeze

2012

Journal of Ethnopharmacology

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“…The better diastolic BP control achieved with valsartan/ hydrochlorothiazide combination could be as a result of reflex increase in sympathetic activity produced by atenolol. Also, atenolol, unlike valsartan, does not improve peripheral vascular resistance, an important contributory factor to systemic hypertension (Cruickshank, 2007;Poirier and Lacourciere, 2012).…”

Section: Discussionmentioning

confidence: 97%

A Comparison of the effects of fixed dose Valsartan/Hydrochlorothiazide and Atenolol/Chlorthalidone on Blood Lipid Profile in Hypertensive Patients

Elekeh¹,

Ughachukwu²,

Unekwe³

et al. 2017

GJMS

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Background: Hypertension is the commonest non-communicable disease and the leading cause of cardiovascular disease in the world. Antihypertensive therapy often produces plasma lipid and glucose derangements. This study, therefore, was designed to find antihypertensive combinations that do not adversely affect plasma lipid and glucose profiles. Method: 240 carefully selected hypertensive patients of both sexes aged between 35-64 years were divided into two groups A and B. Baseline values of systolic and diastolic blood pressure, fasting blood sugar, serum total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride and reduced glutathione (GSH) were recorded. Fixed dose combinations of valsartan 80mg +hydrochlorothiazide 12.5mg (Diovan-HCT) and atenolol 50mg +chlorthalidone 12.5mg ( Diovan-50) were administered orally once daily to group A and group B subjects respectively. Post-treatment values were recorded at the end of six weeks. Results: The valsartan+hydrochlorothiazide combination produced a statistically significant higher reduction in diastolic blood pressure, plasma LDL-C, HDL-C, and triglyceride and a minimal increase in fasting blood compared with atenolol + chlorthalidone combination (p = 0.0001 for all variables). Conclusion: Valsartan + hydrochlorothiazide combination produced a better control of diastolic blood pressure with a favourable effect on FBS, plasma total cholesterol, LDL-C, HDL-C, and GSH.

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“…However, a number of early commentaries and meta-analytic papers and subsequent editorial commentaries continued to appear suggesting that the beta-blocking agents had no place for the initial treatment of patients with hypertension [Opie, 2008;Bangalore et al 2007;Williams, 2006;Beevers, 2005;Messerli et al 2003;1998]. However, other commentaries also in important journals expressed opinions to the contrary [Rahn, 2007;Cruickshank, 2007;2006a;2006b;2002] and strongly opined that the former meta-analysis reports were not uniformly valid and did not take into consideration the primarily older ages of the patients included. Thus, they concluded that the discontinuance of beta-blockers or the recommendation not to use beta-blockers for initial antihypertensive therapy is applicable only to patients older than 60 years of age [Kahn et al 2007;Cruickshank, 2007;2006a;2006b;2002;NICE/BHS 2006;Sever 2006].…”

Section: Age Considerationmentioning

confidence: 99%

“…In response, other reports and editorial commentaries supported the advocacy of the betablockers for option in initial therapy [Cruickshank, 2007;2006a;2006b;2002]. Nevertheless, the beta-blockers continued to be recommended for initial therapy in the United States through the Joint National Committee's Seventh report [Chobanian et al 2003].…”

Section: Introductionmentioning

confidence: 99%

Role of beta-adrenergic receptor blocking agents in hypertensive diseases: personal thoughts as the controversy persists

Fröhlich

2009

Therapeutic Advances in Cardiovascular Disease

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The long history of the beta-adrenergic receptor blockers for the treatment of hypertension is fraught with many controversies. The first compound had severe untoward effects preventing their use until propranolol was introduced. It was found effective for treatment of angina pectoris since not all patients with hypertension responded to monotherapy with a meaningful reduction of pressure. Nevertheless, the beta-blockers were most effective in: younger patients, especially with hyperkinetic circulation; with co-morbid diseases (e.g. coronary arterial disease with or without prior myocardial infarction); or when used with a diuretic. Subsequently with the advent of meta-analysis to evaluate more generalized experience, controversy resumed with statements made to exclude beta-blockers for initial hypertensive therapy. Support for this argument was gained with reports of patients developing 'dysglycemia' with treatment. However, exclusion of any one therapeutic class for a multifactorial disease such as hypertension seems unrealistic. Meta-analysis confounded this conclusion since inadequate numbers of patients having specific clinical and biological characteristics were included (especially young patients). This is particularly important at this time when third-party reimbursement procedures are particularly relevant and when the primary care physician must deal with the individual patient. The NICE report has introduced specific thinking along these lines. In-and-of itself, its recommendations are reasonable, but current articles continue to suggest that the 'older' beta-blockers should be excluded from national guidelines for initial antihypertensive therapy. Personally, I disagree; and, no doubt, controversy will continue.

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Are we misunderstanding beta-blockers

Cited by 95 publications

References 190 publications

Effect of Tulbaghia violacea on the blood pressure and heart rate in male spontaneously hypertensive Wistar rats

Effect of Tulbaghia violacea on the blood pressure and heart rate in male spontaneously hypertensive Wistar rats

A Comparison of the effects of fixed dose Valsartan/Hydrochlorothiazide and Atenolol/Chlorthalidone on Blood Lipid Profile in Hypertensive Patients

Role of beta-adrenergic receptor blocking agents in hypertensive diseases: personal thoughts as the controversy persists

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