Cardiovascular Profile of Propranolol after Multiple Dosing in Infantile Hemangioma

Abstract

Propranolol is becoming the treatment of choice for complicated infantile hemangioma. We report here data on peripheral blood flow, O₂-saturation, electrocardiographic PR-interval, left ventricular function, blood pressure and heart rate that were assessed before and during treatment for ≥4 weeks with propranolol 2 mg/kg of body weight daily in 67 infants <12 months of age in normal sinus rhythm and with structurally normal hearts. Management with propranolol was well tolerated in all and did not modify peripheral blood flow, O₂-saturation, electrocardiographic PR-interval and left ventricular fractional shortening or ejection fraction. Absolute blood pressure levels were similar without and with propranolol. However, age-adjusted centile levels for both systolic and diastolic levels were significantly lower while on propranolol. The heart rate was significantly lower both when expressed as absolute value and when expressed as age-adjusted centile on treatment with propranolol. In conclusion, propranolol 2 mg/kg of body weight daily causes a statistically though not clinically relevant decrease in blood pressure and heart rate in cardially healthy infants affected by infantile hemangioma. Temporary discontinuation during acute febrile illnesses and during diarrheal diseases should be considered to prevent excessive hypotension.

Safety profile during initiation of propranolol for treatment of infantile haemangiomas in an ambulatory day‐care hospitalization setting

“…The age‐adjusted centile levels for systolic and diastolic BP were found to be significantly lower during treatment, and HR was significantly lower in terms of both absolute and age‐adjusted values. Again, none of the adverse findings was clinically relevant …”

“…Others evaluated the effect of propranolol in 67 infants with infantile haemangioma . The age‐adjusted centile levels for systolic and diastolic BP were found to be significantly lower during treatment, and HR was significantly lower in terms of both absolute and age‐adjusted values.…”

“…These findings are similar to previous studies. [22][23][24][25][26] In a study of 109 patients with infantile haemangioma treated with propranolol, comparison with age-specific reference values revealed a decrease in median BP of 5 mmHg, with no clinical symptoms. 14 On monthly follow-up in the maintenance phase, haemodynamic parameters remained stable; only two children had occasional asymptomatic systolic BP values below 70 mmHg.…”

Can the extent of heart rate reduction predict the clinical response of infantile haemangiomas to propranolol?

“…However, they remained clinically well and active with normal blood pressures, hence there was no intervention or change in propranolol dose for either of them. Propranolol causes statistically but usually not clinically significant β1‐receptor‐mediated reduction in HR . Despite this, it would still be more prudent to practise in‐office HR and clinical monitoring, as patients in this age group are unable to verbalize bradycardic symptoms.…”

“…Propranolol causes statistically but usually not clinically significant b1-receptor-mediated reduction in HR. 6 Despite this, it would still be more prudent to practise inoffice HR and clinical monitoring, as patients in this age group are unable to verbalize bradycardic symptoms.…”