Role of Beta-blockers in Cardiovascular Disease in 2019

Martínez‐Milla, Juan; Raposeiras‐Roubín, Sergio; Pascual-Figal, Domingo A.; Ibáñez, Borja

doi:10.1016/j.rec.2019.04.014

Cited by 31 publications

(24 citation statements)

References 72 publications

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“…An additional benefit of metoprolol is the reduction in VF, shown here and in previous clinical trials [26]. In this regard, it has been shown in the pig model of reperfused MI that the incidence of VF (not the number of events or defibrillations) is associated with larger IS [34].…”

Section: Discussionsupporting

confidence: 66%

“…An important difference between the trials is the timing of metoprolol administration. In METOCARD-CNIC, metoprolol was injected immediately after STEMI diagnosis, whereas in the EARLY-BAMI trial, some patients did not receive the full metoprolol dose, or received it when they reached the catheterization lab [26]. Our results reconcile the apparent contradictory trial findings and confirm that metoprolol most likely exerts its cardioprotective effect by slowing IS progression.…”

Section: Discussionmentioning

confidence: 50%

“…The infarct-limiting effects of metoprolol in STEMI patients undergoing PPCI have been tested in two randomized clinical trials (the METOCARD-CNIC [22,27] and the EARLY-BAMI trials [29]), which produced different outcomes [26]. In the METOCARD-CNIC trial, metoprolol administration was associated with smaller infarcts [22] and higher long-term LVEF [27], whereas in the EARLY-BAMI study, metoprolol did not improve clinical outcomes [29].…”

Section: Discussionmentioning

confidence: 99%

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Metoprolol blunts the time-dependent progression of infarct size

et al. 2020

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Early metoprolol administration protects against myocardial ischemia–reperfusion injury, but its effect on infarct size progression (ischemic injury) is unknown. Eight groups of pigs (total n = 122) underwent coronary artery occlusion of varying duration (20, 25, 30, 35, 40, 45, 50, or 60 min) followed by reperfusion. In each group, pigs were randomized to i.v. metoprolol (0.75 mg/kg) or vehicle (saline) 20 min after ischemia onset. The primary outcome measure was infarct size (IS) on day7 cardiac magnetic resonance (CMR) normalized to area at risk (AAR, measured by perfusion computed tomography [CT] during ischemia). Metoprolol treatment reduced overall mortality (10% vs 26%, p = 0.03) and the incidence and number of primary ventricular fibrillations during infarct induction. In controls, IS after 20-min ischemia was ≈ 5% of the area AAR. Thereafter, IS progressed exponentially, occupying almost all the AAR after 35 min of ischemia. Metoprolol injection significantly reduced the slope of IS progression (p = 0.004 for final IS). Head-to-head comparison (metoprolol treated vs vehicle treated) showed statistically significant reductions in IS at 30, 35, 40, and 50-min reperfusion. At 60-min reperfusion, IS was 100% of AAR in both groups. Despite more prolonged ischemia, metoprolol-treated pigs reperfused at 50 min had smaller infarcts than control pigs undergoing ischemia for 40 or 45 min and similar-sized infarcts to those undergoing 35-min ischemia. Day-45 LVEF was higher in metoprolol-treated vs vehicle-treated pigs (41.6% vs 36.5%, p = 0.008). In summary, metoprolol administration early during ischemia attenuates IS progression and reduces the incidence of primary ventricular fibrillation. These data identify metoprolol as an intervention ideally suited to the treatment of STEMI patients identified early in the course of infarction and requiring long transport times before primary angioplasty.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

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Metoprolol blunts the time-dependent progression of infarct size

et al. 2020

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“…β-blockers represent an important antihypertensive drug class which were initially introduced as first line therapy for improving blood pressure control, heart failure, angina, and post-myocardial infarction (10). β-blockers can reduce blood pressure either by reducing CO or systemic vascular resistance (11) and a reduction of blood pressure by 5 mmHg decreases the 10-year risk of stroke by 34% and ischemic heart by 21%, and reduces the possibility of dementia, heart failure, and mortality from cardiovascular disease (12).…”

Section: Introductionmentioning

confidence: 99%

Temporal haemodynamic changes after bisoprolol treatment in patients with uncontrolled hypertension

Zeng¹,

Tomlinson²

2021

Ann Transl Med

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Background: Anti-hypertensive drugs are widely used to control blood pressure, yet their effects on haemodynamics, especially in Chinese populations, and the potential for non-invasive methods to monitor these changes, are poorly understood. This study aimed to determine the early and late effects of bisoprolol treatment on blood pressure, cardiac output (CO), stroke volume (SV), heart rate (HR), systematic vascular resistance (SVR), and inotropy measured in Chinese patients with hypertension.Methods: Twelve Chinese subjects (median age: 55 years, interquartile range: 52-58 years; 33% male) with uncontrolled hypertension were recruited at the Prince of Wales Hospital in Hong Kong and haemodynamic measurements were assessed using a non-invasive Ultrasonic Cardiac Output Monitor (USCOM). Seven hourly measurements were taken before and after bisoprolol 2.5 mg on day 1 (T0 to T6), and in nine patients this was repeated six weeks later (TF0 to TF6). Any BP change of 5 mmHg was considered clinically significant and P<0.05 was considered statistically significant.Results: On day 1 (N=12), there was a significant drop in median CO [4.

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“…β-Blockers have been shown to reduce mortality when used as secondary prevention after infarction, 2 and are an established part of the pharmacological armamentarium, with a class I indication in clinical guidelines. 1 However, early intravenous (i.v.)…”

mentioning

confidence: 99%

Intravenous β-blockers in STEMI: what you are about to do, do it quickly

Ibáñez

2020

European Heart Journal. Acute Cardiovascular Care

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Role of Beta-blockers in Cardiovascular Disease in 2019

Cited by 31 publications

References 72 publications

Metoprolol blunts the time-dependent progression of infarct size

Metoprolol blunts the time-dependent progression of infarct size

Temporal haemodynamic changes after bisoprolol treatment in patients with uncontrolled hypertension

Intravenous β-blockers in STEMI: what you are about to do, do it quickly

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