Beta-blockers and heart failure: meta-analysis of mortality trials

Tj, Cleophas; Ah, Zwinderman

doi:10.5414/cpp39383

Cited by 20 publications

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“…There may be a "high price" to pay for a slight improvement in survival and the "price might be too high" in the elderly with severe symptoms of comorbidity. These results are less impressive than those obtained in previous b-blocker studies (Table 6) [Cleophas and Zwinderman 2001]. In five of these, patients with chronic heart failure treated with nebivolol demonstrated beneficial short-term effects: 10 -28% increase in stroke volume after 4 weeks (p < 0.05) [Lechat 1991, Uhlir 1997; 5 -43% increased ejection fraction (p = 0.002 and p < 0.05) [Brune 1991a, Wisenbaugh et al 1993]; decrease in left ventricular mass (p = 0.04) [Chan et al 1992] and end-systolic volume (p = 0.07) [Chan et al 1992].…”

Section: Clinical Efficacy: Chronic Heart Failure Studiescontrasting

confidence: 83%

“…Fortunately, as described above, the oxidized metabolite of nebivolol is almost as pharmacologically active as its progenitor and, therefore, this is not a clinically important interaction [Vandeplassche 1991]. Such factors, in addition to long-term efficacy, have been assessed in a recently published self-controlled study of 6-month monotherapy with nebivolol in 3,741 patients with mild hypertension [Cleophas et al 2001]. The antihypertensive effects of nebivolol given 5 mg once daily was significantly better than those of 2 × 20 mg nifedipine or 10 mg enalapril daily and equal 50 mg atenolol daily and lisinopril 10 mg daily.…”

Section: Safety Assessmentsmentioning

confidence: 99%

“…Anginal class, according to the Canadian Cardiovascular Society Angina Classification, improved by at least 1 category in 35% of the patients (p < 0.0001), and the benefit/risk ratio, estimated using the ratio of patients with improved anginal class to patients withdrawing because of side effects, was 2.0 (95% confidence intervals 0.9 -4.5, p = 0.07). Mortality results of the recently published Study of Nebivolol Intervention Outcomes and Rehospitaliaztion in Seniors with heart failure (SENIORS) Trial [Flather et al 2005] as compared with the pooled results from a meta-analysis of major b-blockers trials in patients with chronic heart failure previously published by us in this journal [Cleophas and Zwinderman 2001]. Mortality results of the recently published Study of Nebivolol Intervention Outcomes and Rehospitaliaztion in Seniors with heart failure (SENIORS) Trial [Flather et al 2005] as compared with the pooled results from a meta-analysis of major b-blockers trials in patients with chronic heart failure previously published by us in this journal [Cleophas and Zwinderman 2001].…”

Section: Clinical Efficacy: Angina Pectoris Studiesmentioning

confidence: 99%

“…However, the risk of death due to progression of heart failure remained unchanged [Cleophas and Zwinderman 2001]. However, the risk of death due to progression of heart failure remained unchanged [Cleophas and Zwinderman 2001].…”

Section: Clinical Efficacy: Chronic Heart Failure Studiesmentioning

confidence: 99%

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Nebivolol: a review of its clinical and pharmacological characteristics

Gielen¹,

Tj²,

Agrawal³

2006

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Nebivolol is a cardioselective lipophilic b-blocker devoid of intrinsic sympathomimetic and membrane-stabilizing actions. The pharmacological profile differs from that of conventional cardioselective bblockers in that it displays nitric oxide-(NO) mediated vasodilator activity. The net hemodynamic effect of nebivolol is the result of a balance between the depressant effects of bblockade and an action that tends to maintain cardiac output, presumably connected with its afterload reducing vasodilator effect. Recent studies suggest that nebivolol may also restore endothelial dysfunction. Long-term follow-up studies indicate that the compound is efficacious and safe both in patients with mild hypertension and those with stable angina. An interesting effect of chronic nebivolol therapy in elderly patients with mild hypertension is the reversal of a depressor effect into a pressor effect on standing. This action indicates that nebivolol has advantages over other antihypertensive drugs and that it may protect elderly hypertensive patients from orthostatic complaints. The observation that nebivolol improves exercise capacity in nonclaudicant hypertensives is also of clinical interest. Nebivolol resembles serotonin reuptake inhibitors in that it is metabolized by CYP450 2D6 and, therefore, concomitant treatment with serotonin uptake inhibitors may lead to overdosing. Nebivolol compared to placebo does not significantly reduce the mortality risk in elderly subjects. The effects of biological age and comorbidities may be responsible for this finding. In conclusion, clinical studies suggest that nebivolol is effective and safe in patients with hypertension, angina pectoris and heart failure. The beneficial effects on endothelial function, autonomic control and exercise capacity are of considerable clinical interest.Key words nebivolol -b-blockerslipophilicity -autonomic control -endothelial dysfunction -hypertension -isolated systolic hypertension -angina pectoris -heart failurediastolic dysfunction

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Section: Clinical Efficacy: Chronic Heart Failure Studiescontrasting

confidence: 83%

Section: Safety Assessmentsmentioning

confidence: 99%

Section: Clinical Efficacy: Angina Pectoris Studiesmentioning

confidence: 99%

Section: Clinical Efficacy: Chronic Heart Failure Studiesmentioning

confidence: 99%

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Nebivolol: a review of its clinical and pharmacological characteristics

Gielen¹,

Tj²,

Agrawal³

2006

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“…[13][14][15][16][17][18] Although these deaths are often attributed to underlying COPD, the contribution of cardiac disease is thought to be significant. [15][16][17] Beta-blockers reduce mortality in patients with cardiovascular disease, most notably after myocardial infarction, 19 in the presence of congestive heart failure 20 and in the perioperative setting. 21 Patients with COPD are often denied these medications because of possible adverse effects of b blockade on airway function.…”

mentioning

confidence: 99%

Use of blockers and the risk of death in hospitalised patients with acute exacerbations of COPD

Dransfield¹,

Rowe

Johnson

et al. 2008

Thorax

186

110

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Background: Cardiovascular disease is a major cause of death in patients with chronic obstructive pulmonary disease (COPD) and predicts hospitalisation for acute exacerbation, in-hospital death and post-discharge mortality. Although b blockers improve cardiovascular outcomes, patients with COPD often do not receive them owing to concerns about possible adverse pulmonary effects. There are no published data about b blocker use among inpatients with COPD exacerbations. A study was undertaken to identify factors associated with b blocker use in this setting and to determine whether their use is associated with decreased in-hospital mortality. Methods: Administrative data from the University of Alabama Hospital were reviewed and patients admitted between October 1999 and September 2006 with an acute exacerbation of COPD as a primary diagnosis or as a secondary diagnosis with a primary diagnosis of acute respiratory failure were identified. Demographic data, comorbidities and medication use were recorded and subjects receiving b blockers were compared with those who did not. Multivariate regression analysis was performed to determine predictors of in-hospital death after controlling for known covariates and the propensity to receive b blockers. Results: 825 patients met the inclusion criteria. Inhospital mortality was 5.2%. Those receiving b blockers (n = 142) were older and more frequently had cardiovascular disease than those who did not. In multivariate analysis adjusting for potential confounders including the propensity score, b blocker use was associated with reduced mortality (OR = 0.39; 95% CI 0.14 to 0.99). Age, length of stay, number of prior exacerbations, the presence of respiratory failure, congestive heart failure, cerebrovascular disease or liver disease also predicted inhospital mortality (p,0.05). Conclusions: The use of b blockers by inpatients with exacerbations of COPD is well tolerated and may be associated with reduced mortality. The potential protective effect of b blockers in this population warrants further study.Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the USA and the only major cause that is rising in frequency.1 Although many patients with COPD die from respiratory failure, cardiovascular disease is consistently the first or second leading cause of death depending on the severity of the participants' underlying lung disease and the individual study population.2-6 Most of these cardiovascular deaths are due to coronary artery disease which is present in 10-22% of patients with COPD.7 8 This can be attributed to their high prevalence of traditional cardiovascular risk factors (eg, tobacco use, hypertension) and those more recently reported such as systemic inflammation and medication toxicity. 7-12Many COPD deaths occur during hospitalisation for acute exacerbations, a complication which carries an in-hospital mortality as high as 32% and predicts a 1-year mortality of 23-43%. 13-18Although these deaths are often attributed to underlying C...

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β-Blockers as Antiarrhythmic Agents

Priori

Napolitano

Cerrone

Handbook of Experimental Pharmacology

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Beta-blockers and heart failure: meta-analysis of mortality trials

Cited by 20 publications

References 0 publications

Nebivolol: a review of its clinical and pharmacological characteristics

Nebivolol: a review of its clinical and pharmacological characteristics

Use of blockers and the risk of death in hospitalised patients with acute exacerbations of COPD

β-Blockers as Antiarrhythmic Agents

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