Blood pressure lowering efficacy of beta-1 selective beta blockers for primary hypertension

Wong, Gavin WK; Boyda, Heidi N.; Wright, James M

doi:10.1002/14651858.cd007451.pub2

Cited by 43 publications

(11 citation statements)

References 71 publications

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“…Decreasing PR leads to a compensatory increase in cardiac output and elevated systolic BP; prolonged diastolic interval leads to decreasing diastolic BP, which results in widened PP. In the Cochrane Database of Systematic Reviews, β‐blockers reduced BP (systolic BP: −10 mm Hg, diastolic BP: −8 mm Hg) and lowered PR (−11 bpm) but did not reduce PP . The elevated sympathetic nervous activity contributes to accelerated arterial stiffening .…”

Section: Discussionmentioning

confidence: 99%

Single‐pill combination of cilnidipine, an L‐/N‐type calcium channel blocker, and valsartan effectively reduces home pulse pressure in patients with uncontrolled hypertension and sympathetic hyperactivity: The HOPE‐Combi survey

Kario

Matsuda

Nagahama

et al. 2020

J of Clinical Hypertension

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The home blood pressure (BP) control by a single‐pill combination of cilnidipine (an L‐/N‐type calcium channel blocker; CCB) and valsartan (HOPE‐Combi) survey is a multicenter, post‐marketing, prospective observational study of a single‐pill combination of cilnidipine 10 mg and valsartan 80 mg (SPC of Cil/Val) in patients with uncontrolled hypertension. We examined the effects of the SPC of Cil/Val on morning home systolic BP (MHSBP) and morning home pulse pressure (MHPP) of 1036 patients with hypertension over 12 months. MHSBP decreased by 14.0 mm Hg (P < .01), and MHPP decreased by 6.6 mm Hg (P < .01). Moreover, morning home pulse rate (MHPR) decreased by 2.1 bpm (P < .01). A more progressive and greater decrease in MHSBP (−17.2 vs −10.3 mm Hg, P < .01) and MHPP (−7.6 vs −4.9 mm Hg, P < .01) was observed in patients with higher MHPR (≥70 bpm) than in those with lower MHPR (<70 bpm) over the treatment period. In particular, in patients with a wide MHPP (≥70 mm Hg), the difference in the MHPP reduction was greater in patients with higher MHPR than in those with lower MHPR (−17.9 vs −13.6 mm Hg, P < .01). These results suggested that the SPC of Cil/Val, which possesses the unique sympatholytic characteristics of an L‐/N‐type CCB, was particularly effective in patients with uncontrolled hypertension and sympathetic hyperactivity.

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Section: Discussionmentioning

confidence: 99%

Single‐pill combination of cilnidipine, an L‐/N‐type calcium channel blocker, and valsartan effectively reduces home pulse pressure in patients with uncontrolled hypertension and sympathetic hyperactivity: The HOPE‐Combi survey

Kario

Matsuda

Nagahama

et al. 2020

J of Clinical Hypertension

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“…Our study confirmed, with appropriate controls, that mean arterial blood pressure decreased in an amount similar to reported values for beta-adrenergic antagonists that are also clinically effective to not only reduce blood pressure, and in humans can cause fatigue (16). In a review of 56 randomized controlled trials examining the blood pressure lowering effects of beta-1 selective blockers, the average reduction in blood pressure was 10 and 8 mmHg in systolic and diastolic blood pressure, respectively, in patients with mild to moderate hypertension (17). An associated side effect of the beta-blocker propranolol is fatigue (18).…”

Section: Discussionmentioning

confidence: 99%

Radio-Telemetric Assessment of Cardiac Variables and Locomotion With Experimentally Induced Hypermagnesemia in Horses Using Chronically Implanted Catheters

et al. 2019

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The objective of this study was to characterize the pharmacokinetics and pharmacodynamics of intravenous administration of magnesium sulfate to horses using a novel radio-telemetry system for physiologic signal capture. Five Horses were surgically implanted with a radio-telemetric carotid catheter. Implants were paired with a non-invasive telemetric unit which acquired a six lead ECG and 3-axis acceleration to assess activity acquired wirelessly in real-time for future analysis. Horses were exposed to a new stall environment before (baseline) and after 60 mg/kg (30 mL) of magnesium sulfate (MgSO4), or the same volume of 0.9% saline, administered intravenously in a blinded, random crossover design. Blood for pharmacokinetics, telemetric data, and body temperature were recorded serially for 24 h. Data were analyzed across time and between treatments. Significance was set at P < 0.05. Ionized magnesium concentration (Mg2+) increased and the Ca2+ to Mg2+ ratio decreased and persisted for 5 h after MgSO4 administration. Heart rate (HR) increased and mean arterial blood pressure (MAP) decreased for at least 6 h. Electrocardiogram (ECG) intervals (RR) decreased and (PR and QTc) increased in duration compared to controls indicating an increase in heart rate, and slower myocardial conduction in the MgSO4 group. Acceleration in all planes was less in the MgSO4 group compared to controls indicating decreased locomotion. This novel method permitted collection of physiologic signals without interference by handlers or animal restraint. An intravenous bolus of MgSO4 produced cardiac variable changes associated with the reduction of locomotion in these horses, and in a direction that may be causal. Locomotion was decreased when horses were first introduced into a new environment which reflects the calming effect desired in sport horses. Telemetric monitoring can be used as a model to elucidate the behavior and physiologic effects of other drugs. The administration of MgSO4 may be detected for regulatory purposes with the monitoring of Mg2+ and Ca2+ concentrations and their ratio.

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“…In particular, studies aimed at clarifying the effects of carvedilol and nebivolol would be valuable given that recent meta-analyses suggested that BP lowering by combined β/α-receptor blockers (ie, carvedilol) was less effective than by β 1 -selective blockers (ie, nebivolol). 49,50 As the most frequently used and preferred source of education by physicians in this study, CME modules and peer-reviewed publications may provide greater benefit than other initiatives for accessible and consistent educational efforts.…”

Section: Discussionmentioning

confidence: 99%

Insights on β‐blockers for the treatment of hypertension: A survey of health care practitioners

Egan

Flack

Patel

et al. 2018

J of Clinical Hypertension

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A quantitative survey was completed by 103 primary care physicians (PCPs) and 59 cardiologists who regularly prescribed β‐blockers to assess knowledge and use of this heterogeneous drug class for hypertension. More cardiologists than PCPs chose β‐blockers as initial antihypertensive therapy (30% vs 17%, P < 0.01). Metoprolol and carvedilol were the most commonly prescribed β‐blockers. Cardiologists rated “impact on energy” and “arterial vasodilation” as more important than PCPs (P < 0.05/<0.01, respectively). Awareness of vasodilation was greater for carvedilol (52%) than nebivolol (31%). Association between β‐blockers and clinical variables included nebivolol with β1‐selectivity, nebivolol and carvedilol with vasodilation and efficacy in older patients and African Americans, metoprolol with heart rate reduction, and atenolol and metoprolol with weight gain and hyperglycemia. Physicians preferred prescribing β‐blockers with lower risk of incident diabetes. Clinical practice guidelines influenced physician prescribing more than formularies or performance metrics. This survey captures physicians’ perceptions/use of various β‐blockers and clinically relevant knowledge gaps.

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Blood pressure lowering efficacy of beta-1 selective beta blockers for primary hypertension

Cited by 43 publications

References 71 publications

Single‐pill combination of cilnidipine, an L‐/N‐type calcium channel blocker, and valsartan effectively reduces home pulse pressure in patients with uncontrolled hypertension and sympathetic hyperactivity: The HOPE‐Combi survey

Single‐pill combination of cilnidipine, an L‐/N‐type calcium channel blocker, and valsartan effectively reduces home pulse pressure in patients with uncontrolled hypertension and sympathetic hyperactivity: The HOPE‐Combi survey

Radio-Telemetric Assessment of Cardiac Variables and Locomotion With Experimentally Induced Hypermagnesemia in Horses Using Chronically Implanted Catheters

Insights on β‐blockers for the treatment of hypertension: A survey of health care practitioners

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