Non-selective beta blockers(NSBB) are commonly used to prevent portal hypertensive bleeding in cirrhotics.Nevertheless, in the last years, the use of NSBB in critically decompensated patients, especially in those with...Non-selective beta blockers(NSBB) are commonly used to prevent portal hypertensive bleeding in cirrhotics.Nevertheless, in the last years, the use of NSBB in critically decompensated patients, especially in those with refractory ascites, has been questioned, mainly for an increased risk of mortality and worsening of systemic hemodynamics. Moreover, even if NSBB have been reported to correlate with a higher risk of renal failure and severe infection in patients with advanced liver disease and hypotension, their use has been associated with a reduction of risk of spontaneous bacterial peritonitis, modification of gut permeability and reduction of bacterial translocation. This manuscript systematically reviews the published evidences about harms and benefits of the use of NSBB in patients with decompensated cirrhosis.展开更多
Background: Cardiac failure treatment largely focused on symptomatic relief at the expense of the address of the underlying disease process of cardiac remodelling. This old wisdom of practice has been turned around by...Background: Cardiac failure treatment largely focused on symptomatic relief at the expense of the address of the underlying disease process of cardiac remodelling. This old wisdom of practice has been turned around by clinical research findings that have shown that there are agents that reverse cardiac remodelling and offer long-term benefits to cardiac failure patients. This has led to the recommendation of evidence-based practice in chronic heart failure management using reverse modelling agents such as beta blockers. Objectives: To ascertain the prescribing patterns of beta blockers in cardiac failure patients by doctors in a public hospital setting and determine the prevalence of cardiac failure hospitalisation and the age groups involved. Study design: A retrospective medical records review observational study. Methodology: A sample size of 385 cardiac failure cases was used. Data on cardiac failure patients who were once hospitalised at the hospital of study were abstracted from the patients’ medical records files using data collection forms. Results: There were 36 (9.4%) patients who were prescribed beta blockers, 7 patients had their beta blocker substituted for another. Atenolol was prescribed to 30 (7.8%) patients, propranolol to 7 (1.8%) and carvedilol to 6 (1.6%) patients. Metoprolol and bisoprolol were not prescribed at all. There were more females (57.9%) than males (42.1%) and the mean age was 41.9 (standard deviation 24.0) years. The prevalence of cardiac failure hospitalisation was 1.54%. Conclusion: The rate of beta blocker prescribing was low. There is need for emphasis on evidence-based treatment options in the management of cardiac failure in Zimbabwe.展开更多
Beta blockers(BB)are widely used for the treatment of cardiovascular diseases to reduce heart rate and hence the myocardial oxygen consumption[1].Of note,studies found BB may confer clinical benefits in critically ill...Beta blockers(BB)are widely used for the treatment of cardiovascular diseases to reduce heart rate and hence the myocardial oxygen consumption[1].Of note,studies found BB may confer clinical benefits in critically ill patients,though confirmatory evidence is still lacking.展开更多
Background:Prospective randomized trials in severely burned children have shown the positive effects of oxandrolone(OX),beta blockers(BB)and a combination of the two(BBOX)on hypermetabolism,catabolism and hyperinflamm...Background:Prospective randomized trials in severely burned children have shown the positive effects of oxandrolone(OX),beta blockers(BB)and a combination of the two(BBOX)on hypermetabolism,catabolism and hyperinflammation short-and long-term post-burn.Although data on severely burned adults are lacking in comparison,BB,OX and BBOX appear to be commonly employed in this patient population.In this study,we perform a secondary analysis of an international prospective randomized trial dataset to provide descriptive evidence regarding the current utilization patterns and potential treatment effects of OX,BB and BBOX.Methods:The RE-ENERGIZE(RandomizEd Trial of ENtERal Glutamine to minimIZE Thermal Injury,NCT00985205)trial included 1200 adult patients with severe burns.We stratified patients according to their receipt of OX,BB,BBOX or none of these drugs(None)during acute hospitalization.Descriptive statistics describe the details of drug therapy and unadjusted analyses identify predisposing factors for drug use per group.Association between OX,BB and BBOX and clinical outcomes such as time to discharge alive and 6-month mortality were modeled using adjusted multivariable Cox regressions.Results:More than half of all patients in the trial received either OX(n=138),BB(n=293)or BBOX(n=282),as opposed to None(n=487,40.6%).Per study site and geographical region,use of OX,BB and BBOX was highly variable.Predisposing factors for the use of OX,BB and BBOX included larger total body surface area(TBSA)burned,higher acute physiology and chronic health evaluation(APACHE)II scores on admission and younger patient age.After adjustment for multiple covariates,the use of OX was associated with a longer time to discharge alive[hazard ratio(HR)0.62,confidence interval(CI)(0.47-0.82)per 100%increase,p=0.001].A higher proportion of days on BB was associated with lower in-hospital-mortality(HR:0.5,CI 0.28-0.87,p=0.015)and 6-month mortality(HR:0.44,CI 0.24-0.82,p=0.01).Conclusions:The use of OX,BB and BBOX is common within the adult burn patient population,with its use varying considerably across sites worldwide.Our findings found mixed associations between outcomes and the use of BB and OX in adult burn patients,with lower acute and 6-month-mortality with BB and longer times to discharge with OX.Further research into these pharmacological modulators of the pathophysiological response to severe burn injury is indicated.展开更多
AIM:To explore effects of nonselective beta-blockers(NSBBs) in cirrhotic patients with no or small varices.METHODS:The Pub Med,EMBASE,Science Direct,and Cochrane library databases were searched for relevant papers.A m...AIM:To explore effects of nonselective beta-blockers(NSBBs) in cirrhotic patients with no or small varices.METHODS:The Pub Med,EMBASE,Science Direct,and Cochrane library databases were searched for relevant papers.A meta-analysis was performed using ORs with 95%CI as the effect sizes.Subgroup analysis was conducted according to the studies including patients without varices and those with small varices.RESULTS:Overall,784 papers were initially retrieved from the database searches,of which six randomized controlled trials were included in the meta-analysis.The incidences of large varices development(OR = 1.05,95%CI:0.25-4.36;P = 0.95),first upper gastrointestinal bleeding(OR = 0.59,95%CI:0.24-1.47;P = 0.26),and death(OR = 0.70,95%CI:0.45-1.10;P = 0.12) were similar between NSBB and placebo groups.However,the incidence of adverse events was significantly higher in the NSBB group compared with the placebo group(OR = 3.47,95%CI:1.45-8.33;P = 0.005).The results of subgroup analyses were similar to those of overall analyses.CONCLUSION:The results of this meta-analysis indicate that NSBBs should not be recommended for cirrhotic patients with no or small varices.展开更多
Background Because limited comparative data are available,we decided to compare 2-year major clinical outcomes between beta-blockers (BB) with angiotensin converting enzyme inhibitors (ACEI) and BB with angiotensin re...Background Because limited comparative data are available,we decided to compare 2-year major clinical outcomes between beta-blockers (BB) with angiotensin converting enzyme inhibitors (ACEI) and BB with angiotensin receptor blockers (ARB) therapy in patients with non-ST-segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).Methods A total 11,288 NSTEMI patients who underwent PCI with DES were enrolled and they were divided into two groups,the BB with ACEI group (n = 7600) and the BB with ARB group (n = 3688).The major clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death,recurrent myocardial infarction (re-MI),total revascularization [target lesion revascularization (TLR),target vessel revascularization (TVR),non-TVR] rate during the 2-year follow-up period.Results After propensity score-matched (PSM) analysis,two PSM groups (3317 pairs,n = 6634,C-statistic = 0.695) were generated.Although the cumulative incidences of all-cause death,cardiac death,TLR,and non-TVR were similar between the two groups,MACE (HR = 0.832,95% CI: 0.704?0.982,P = 0.030),total revascularization rate (HR = 0.767,95% CI: 0.598?0.984,P = 0.037),and TVR rate (HR = 0.646,95% CI: 0.470?0.888,P = 0.007) were significantly lower in the BB with ACEI group after PSM.Conclusions In this study,we suggest that the combination of BB with ACEI may be beneficial for reducing the cumulative incidences of MACE,total revascularization rate,and TVR rather than the BB with ARB after PCI with DES in NSTEMI patients.展开更多
The best protocol of perioperative beta-blockers remains uncertain.Previous studies have demonstrated that tight heart rate control by beta-blockers reduced perioperative myocardial ischemia and improved clinical outc...The best protocol of perioperative beta-blockers remains uncertain.Previous studies have demonstrated that tight heart rate control by beta-blockers reduced perioperative myocardial ischemia and improved clinical outcomes.However,the recent studies have failed to provide evidence to support perioperative beta blockers,with potential increased mortality as showed in the POISE trial.In this paper,perioperative use of beta-blockers will be discussed,especially about the evolution of their perioperative therapeutic application and current status.展开更多
AIM To investigate beta-blocker(BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.METHODS Adult outpatients with cirrhosis listed for liver transplantation underwe...AIM To investigate beta-blocker(BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.METHODS Adult outpatients with cirrhosis listed for liver transplantation underwent testing of physical frailty using the performance-based Liver Frailty Index, comprised of chair stands, grip strength, and balance testing, as well as self-reported assessments of exhaustion and physical activity. BB use was assessed from medical chart review. Univariable and multivariable logistic regression were performed to determine BB use and their association with measures of physical frailty. Competing risk analyses were performed to determine the effect of BB use on wait-list mortality, as defined by death or delisting for being too sick for transplant.RESULTS Of 344 patients, 35% were female, median age was 60, median model for end stage liver disease was 15, and 53% were prescribed a BB. Compared to those not on BB, patients on BB were similar except for percentage female(25% vs 46%; P < 0.001) and BMI(29 vs 28; P = 0.008). With respect to tests of physical frailty, BB use was not associated with increased odds of frailty(by the Liver Frailty Index), exhaustion, or low physical activity. BB use was, however, significantly associated with a decreased adjusted risk of mortality(SHR 0.55; P = 0.005).CONCLUSION In patients with cirrhosis awaiting liver transplantation, BB use is not associated with physical frailty. We confirmed the known survival benefits with BB use, and concerns about adverse effects should not deter their utilization when indicated.展开更多
Background: Randomized trials have demonstrated the efficacy of beta-blockers (BBs) in heart failure (HF) patients. We sought to assess the impact of BBs on long-term outcome;in particular, we assessed the association...Background: Randomized trials have demonstrated the efficacy of beta-blockers (BBs) in heart failure (HF) patients. We sought to assess the impact of BBs on long-term outcome;in particular, we assessed the association between outcome and BB dose and discharge heart rate. Methods and Results: Prescriptions for dispensed medication and outcomes were identified from a prospective, single-institution HF registry. Long-term prognosis was compared between users and non-users of BBs. BB users were further divided into 2 groups based on dose (full and non-full dose) and discharge heart rate (70 bpm was significantly associated with impaired long-term outcome (HR = 1.872, P = 0.04). Conclusions: Optimizing heart rate, rather than maximizing BB dose, appears to be an appropriate treatment strategy for the beta-sensitive Japanese population.展开更多
This paper reported beta-blocker use in 21 STEMI patients over four years. The patients were between 50 - 65 years of age presenting with anterior, lateral, and inferior STEMI (ST-Elevation Myocardial Infarction). Sev...This paper reported beta-blocker use in 21 STEMI patients over four years. The patients were between 50 - 65 years of age presenting with anterior, lateral, and inferior STEMI (ST-Elevation Myocardial Infarction). Seven of the patients were female, and 14 were male. They presented to an emergency room of a rural hospital that did not provide emergency percutaneous coronary angioplasty/stenting (PTCA/stenting). The hospital is about 70 minutes from a facility that provided PTCA/ stenting—all the patients presented with typical angina chest pain with ST elevation. They are hemodynamic stable. Most patients received Lopressor 35 mg IVP, with one receiving 115 mg in a 5 mg increment. They were chest pain-free and hemodynamically before leaving the ER for the transfer for PTCA/stent. The results demonstrated that beta-blockers are effective in relieving pain in STEMI patients. Further study is needed to determine its efficacy, safety, and how to use it.展开更多
Background: Depression and ischemic heart disease (IHD) are associated with persistent stress and autonomic nervous system (ANS) dysfunction. The former can be measured by pressure pain sensitivity (PPS) of the sternu...Background: Depression and ischemic heart disease (IHD) are associated with persistent stress and autonomic nervous system (ANS) dysfunction. The former can be measured by pressure pain sensitivity (PPS) of the sternum, and the latter by the PPS and systolic blood pressure (SBP) response to a tilt table test (TTT). Beta-blocker treatment reduces the efferent beta-adrenergic ANS function, and thus, the physiological stress response. Objective: To test the effect of beta-blockers on changes in depression score in patients with IHD, as well as the influence on persistent stress and ANS dysfunction. Methods: Three months of non-pharmacological intervention aiming at reducing PPS and depression score in patients with stable IHD. Beta-blocker users (N = 102) were compared with non-users (N = 75), with respect to signs of depression measured by the Major Depressive Inventory questionnaire (MDI), resting PPS, and PPS and SBP response to TTT. Results: MDI score decreased 30% in non-users (p = 0.005) compared to 4% (p > 0.1) among users (between-group p = 0.003;effect size = 0.4). Resting PPS decreased in both the groups. Among most vulnerable patients with MDI ≥ 15, reductions in MDI score and resting PPS score correlated in non-users, only (r = 0.69, p = 0.007). Reduction in resting PPS correlated with an increase in PPS and SBP response to TTT. Conclusions: Stress intervention in patients with IHD was anti-depressive in non-users, only. Similarly, the association between the reduction in depression, reduction in persistent stress, and restoration of ANS dysfunction was only seen in non-users, suggesting a central role of beta-adrenergic receptors in the association between these factors.展开更多
Ivabradine,a selective inhibitor of the funny current in the sinoatrial node,has emerged as a promising agent for heart rate modulation in acute and critical care settings.Unlike beta-blockers,ivabradine reduces heart...Ivabradine,a selective inhibitor of the funny current in the sinoatrial node,has emerged as a promising agent for heart rate modulation in acute and critical care settings.Unlike beta-blockers,ivabradine reduces heart rate without affecting myocardial contractility,making it a valuable option for patients contraindicated for traditional therapies.This review examines its mechanism of action,clinical applications,comparative efficacy,and safety profile.It incorporates recent literature to assess its expanding role in managing acute coronary syndrome,acute decompensated heart failure,and sepsis-induced tachycardia.展开更多
Objective To investigate the effects of ascites grading and the application of non-selective beta-blockers(NSBBs)on the 1-year prognosis of acute-on-chronic liver failure(ACLF).Methods 1386 ascitic cases with ACLF wer...Objective To investigate the effects of ascites grading and the application of non-selective beta-blockers(NSBBs)on the 1-year prognosis of acute-on-chronic liver failure(ACLF).Methods 1386 ascitic cases with ACLF were graded and followed up for one year.The 1-year prognostic effect of ascites grade and NSBBs was analyzed on ACLF by the Kaplan Meier Log-rank test,Cox stepwise regression,and multivariate regression.The t-test,Mann-Whitney U,or Kruskal-Wallis test were used for intergroup comparison of measurement data.The X test was used for intergroup comparison of numerical data.Results The incidence rate of ascites at admission was 77.56%in1386ACLFcases.The Log-rank(Mantel-Cox)of the 1-year survival curve test for 1386 ACLF patients with ascites grade was 21.384,P<0.01.Multivariate regression and Cox stepwise regression analysis showed that ascites grade,age,gastrointestinal bleeding,pulmonary infection,acute kidney injury,prothrombin activity(PTA),urea,MELD-Na score,and the use of NSBBs were closely related to the 1-year prognosis of ACLF.The log rank(Mantel-Cox)of NSBBs treatment in the grade 2/3 ascites group was 6.113,P=0.013,and the difference was statistically significant,suggesting that NSBBs treatment can help improve the 1-year survival rate in ACLF patients with grade 2 and 3 ascites.Conclusion Ascites grading and the use of NSBBs affect the prognostic factor of ACLF at one year.NSBBs may be beneficial for the long-term prognosis of ACLF,and treatment can be continued in patients who have already received NSBBs prior to the onset of ACLF.展开更多
目的:分析选择性β_(1)受体阻滞剂治疗高血压的有效性和安全性,进一步更新选择性β_(1)受体阻滞剂的循证医学证据。方法:计算机检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Embase、Coc...目的:分析选择性β_(1)受体阻滞剂治疗高血压的有效性和安全性,进一步更新选择性β_(1)受体阻滞剂的循证医学证据。方法:计算机检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Embase、Cochrane Library,搜集关于选择性β_(1)受体阻滞剂治疗高血压患者的随机对照试验,检索时间均为建库至2024年5月。由两名研究者独立进行文献进行筛选、提取资料并评估纳入研究的偏倚风险,采用Cochrane偏倚风险工具对纳入研究进行质量评价,采用R4.4.0软件进行网状Meta分析,计算各结局指标的累积排序概率图下面积(the surface under the cumulative ranking,SUCRA)以比较不同干预措施的有效性与安全性。结果:SUCRA值排序结果显示,在降低收缩压方面:比索洛尔(79.33%)>阿替洛尔(57.46%)>美托洛尔缓释剂(51.12%)>美托洛尔速释剂(12.08%);降低舒张压方面:压比索洛尔(77.38%)>阿替洛尔(65.63%)>美托洛尔缓释剂(51.41%)>美托洛尔速释剂(5.57%);降低24 h动态收缩压方面:比索洛尔(92.44%)>美托洛尔速释剂(54.09%)>美托洛尔缓释剂(52.47%)>阿替洛尔(1.01%);降低24 h动态舒张压方面:比索洛尔(95.24%)>美托洛尔速释剂(52.52%)>美托洛尔缓释剂(46.82%)>阿替洛尔(5.4%);降低心率幅度方面:比索洛尔(97.88%)>阿替洛尔(66.98%)>美托洛尔缓释剂(22.72%)>美托洛尔速释剂(12.42%);降低24 h动态心率方面:美托洛尔缓释剂(69.49%)>比索洛尔(54.97%)>阿替洛尔(39.39%)>美托洛尔速释剂(36.17%);不良反应发生率方面:阿替洛尔(81.38%)>美托洛尔缓释剂(54.86%)>比索洛尔(48.97%)>美托洛尔速释剂(14.79%)。结论:比索洛尔、阿替洛尔、美托洛尔速释剂和美托洛尔缓释剂治疗高血压时均有明显的有效性,其中比索洛尔的有效性最为显著,而阿替洛尔的总不良反应发生率较高,临床使用时应给予关注。展开更多
文摘Non-selective beta blockers(NSBB) are commonly used to prevent portal hypertensive bleeding in cirrhotics.Nevertheless, in the last years, the use of NSBB in critically decompensated patients, especially in those with refractory ascites, has been questioned, mainly for an increased risk of mortality and worsening of systemic hemodynamics. Moreover, even if NSBB have been reported to correlate with a higher risk of renal failure and severe infection in patients with advanced liver disease and hypotension, their use has been associated with a reduction of risk of spontaneous bacterial peritonitis, modification of gut permeability and reduction of bacterial translocation. This manuscript systematically reviews the published evidences about harms and benefits of the use of NSBB in patients with decompensated cirrhosis.
文摘Background: Cardiac failure treatment largely focused on symptomatic relief at the expense of the address of the underlying disease process of cardiac remodelling. This old wisdom of practice has been turned around by clinical research findings that have shown that there are agents that reverse cardiac remodelling and offer long-term benefits to cardiac failure patients. This has led to the recommendation of evidence-based practice in chronic heart failure management using reverse modelling agents such as beta blockers. Objectives: To ascertain the prescribing patterns of beta blockers in cardiac failure patients by doctors in a public hospital setting and determine the prevalence of cardiac failure hospitalisation and the age groups involved. Study design: A retrospective medical records review observational study. Methodology: A sample size of 385 cardiac failure cases was used. Data on cardiac failure patients who were once hospitalised at the hospital of study were abstracted from the patients’ medical records files using data collection forms. Results: There were 36 (9.4%) patients who were prescribed beta blockers, 7 patients had their beta blocker substituted for another. Atenolol was prescribed to 30 (7.8%) patients, propranolol to 7 (1.8%) and carvedilol to 6 (1.6%) patients. Metoprolol and bisoprolol were not prescribed at all. There were more females (57.9%) than males (42.1%) and the mean age was 41.9 (standard deviation 24.0) years. The prevalence of cardiac failure hospitalisation was 1.54%. Conclusion: The rate of beta blocker prescribing was low. There is need for emphasis on evidence-based treatment options in the management of cardiac failure in Zimbabwe.
基金supported by Jiangsu Province Traditional Chinese Medicine Technology Development Plan Project(QN202305)National Natural Science Foundation of China(82474636).
文摘Beta blockers(BB)are widely used for the treatment of cardiovascular diseases to reduce heart rate and hence the myocardial oxygen consumption[1].Of note,studies found BB may confer clinical benefits in critically ill patients,though confirmatory evidence is still lacking.
基金Supported by the U.S.Department of Defense(award number,W81XWH-09-2-0194 for the pilot phase)the Canadian Institutes of Health Research(funding reference numbers,MCT-94834 for the pilot phase and 14238 for the definitive phase).
文摘Background:Prospective randomized trials in severely burned children have shown the positive effects of oxandrolone(OX),beta blockers(BB)and a combination of the two(BBOX)on hypermetabolism,catabolism and hyperinflammation short-and long-term post-burn.Although data on severely burned adults are lacking in comparison,BB,OX and BBOX appear to be commonly employed in this patient population.In this study,we perform a secondary analysis of an international prospective randomized trial dataset to provide descriptive evidence regarding the current utilization patterns and potential treatment effects of OX,BB and BBOX.Methods:The RE-ENERGIZE(RandomizEd Trial of ENtERal Glutamine to minimIZE Thermal Injury,NCT00985205)trial included 1200 adult patients with severe burns.We stratified patients according to their receipt of OX,BB,BBOX or none of these drugs(None)during acute hospitalization.Descriptive statistics describe the details of drug therapy and unadjusted analyses identify predisposing factors for drug use per group.Association between OX,BB and BBOX and clinical outcomes such as time to discharge alive and 6-month mortality were modeled using adjusted multivariable Cox regressions.Results:More than half of all patients in the trial received either OX(n=138),BB(n=293)or BBOX(n=282),as opposed to None(n=487,40.6%).Per study site and geographical region,use of OX,BB and BBOX was highly variable.Predisposing factors for the use of OX,BB and BBOX included larger total body surface area(TBSA)burned,higher acute physiology and chronic health evaluation(APACHE)II scores on admission and younger patient age.After adjustment for multiple covariates,the use of OX was associated with a longer time to discharge alive[hazard ratio(HR)0.62,confidence interval(CI)(0.47-0.82)per 100%increase,p=0.001].A higher proportion of days on BB was associated with lower in-hospital-mortality(HR:0.5,CI 0.28-0.87,p=0.015)and 6-month mortality(HR:0.44,CI 0.24-0.82,p=0.01).Conclusions:The use of OX,BB and BBOX is common within the adult burn patient population,with its use varying considerably across sites worldwide.Our findings found mixed associations between outcomes and the use of BB and OX in adult burn patients,with lower acute and 6-month-mortality with BB and longer times to discharge with OX.Further research into these pharmacological modulators of the pathophysiological response to severe burn injury is indicated.
文摘AIM:To explore effects of nonselective beta-blockers(NSBBs) in cirrhotic patients with no or small varices.METHODS:The Pub Med,EMBASE,Science Direct,and Cochrane library databases were searched for relevant papers.A meta-analysis was performed using ORs with 95%CI as the effect sizes.Subgroup analysis was conducted according to the studies including patients without varices and those with small varices.RESULTS:Overall,784 papers were initially retrieved from the database searches,of which six randomized controlled trials were included in the meta-analysis.The incidences of large varices development(OR = 1.05,95%CI:0.25-4.36;P = 0.95),first upper gastrointestinal bleeding(OR = 0.59,95%CI:0.24-1.47;P = 0.26),and death(OR = 0.70,95%CI:0.45-1.10;P = 0.12) were similar between NSBB and placebo groups.However,the incidence of adverse events was significantly higher in the NSBB group compared with the placebo group(OR = 3.47,95%CI:1.45-8.33;P = 0.005).The results of subgroup analyses were similar to those of overall analyses.CONCLUSION:The results of this meta-analysis indicate that NSBBs should not be recommended for cirrhotic patients with no or small varices.
基金supported by Research of Korea Centers for Disease Control and Prevention (2016-ER6304-02)
文摘Background Because limited comparative data are available,we decided to compare 2-year major clinical outcomes between beta-blockers (BB) with angiotensin converting enzyme inhibitors (ACEI) and BB with angiotensin receptor blockers (ARB) therapy in patients with non-ST-segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).Methods A total 11,288 NSTEMI patients who underwent PCI with DES were enrolled and they were divided into two groups,the BB with ACEI group (n = 7600) and the BB with ARB group (n = 3688).The major clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death,recurrent myocardial infarction (re-MI),total revascularization [target lesion revascularization (TLR),target vessel revascularization (TVR),non-TVR] rate during the 2-year follow-up period.Results After propensity score-matched (PSM) analysis,two PSM groups (3317 pairs,n = 6634,C-statistic = 0.695) were generated.Although the cumulative incidences of all-cause death,cardiac death,TLR,and non-TVR were similar between the two groups,MACE (HR = 0.832,95% CI: 0.704?0.982,P = 0.030),total revascularization rate (HR = 0.767,95% CI: 0.598?0.984,P = 0.037),and TVR rate (HR = 0.646,95% CI: 0.470?0.888,P = 0.007) were significantly lower in the BB with ACEI group after PSM.Conclusions In this study,we suggest that the combination of BB with ACEI may be beneficial for reducing the cumulative incidences of MACE,total revascularization rate,and TVR rather than the BB with ARB after PCI with DES in NSTEMI patients.
文摘The best protocol of perioperative beta-blockers remains uncertain.Previous studies have demonstrated that tight heart rate control by beta-blockers reduced perioperative myocardial ischemia and improved clinical outcomes.However,the recent studies have failed to provide evidence to support perioperative beta blockers,with potential increased mortality as showed in the POISE trial.In this paper,perioperative use of beta-blockers will be discussed,especially about the evolution of their perioperative therapeutic application and current status.
基金Supported by the Paul B.Beeson Career Development Award in Aging Research,No.K23AG048337
文摘AIM To investigate beta-blocker(BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.METHODS Adult outpatients with cirrhosis listed for liver transplantation underwent testing of physical frailty using the performance-based Liver Frailty Index, comprised of chair stands, grip strength, and balance testing, as well as self-reported assessments of exhaustion and physical activity. BB use was assessed from medical chart review. Univariable and multivariable logistic regression were performed to determine BB use and their association with measures of physical frailty. Competing risk analyses were performed to determine the effect of BB use on wait-list mortality, as defined by death or delisting for being too sick for transplant.RESULTS Of 344 patients, 35% were female, median age was 60, median model for end stage liver disease was 15, and 53% were prescribed a BB. Compared to those not on BB, patients on BB were similar except for percentage female(25% vs 46%; P < 0.001) and BMI(29 vs 28; P = 0.008). With respect to tests of physical frailty, BB use was not associated with increased odds of frailty(by the Liver Frailty Index), exhaustion, or low physical activity. BB use was, however, significantly associated with a decreased adjusted risk of mortality(SHR 0.55; P = 0.005).CONCLUSION In patients with cirrhosis awaiting liver transplantation, BB use is not associated with physical frailty. We confirmed the known survival benefits with BB use, and concerns about adverse effects should not deter their utilization when indicated.
文摘Background: Randomized trials have demonstrated the efficacy of beta-blockers (BBs) in heart failure (HF) patients. We sought to assess the impact of BBs on long-term outcome;in particular, we assessed the association between outcome and BB dose and discharge heart rate. Methods and Results: Prescriptions for dispensed medication and outcomes were identified from a prospective, single-institution HF registry. Long-term prognosis was compared between users and non-users of BBs. BB users were further divided into 2 groups based on dose (full and non-full dose) and discharge heart rate (70 bpm was significantly associated with impaired long-term outcome (HR = 1.872, P = 0.04). Conclusions: Optimizing heart rate, rather than maximizing BB dose, appears to be an appropriate treatment strategy for the beta-sensitive Japanese population.
文摘This paper reported beta-blocker use in 21 STEMI patients over four years. The patients were between 50 - 65 years of age presenting with anterior, lateral, and inferior STEMI (ST-Elevation Myocardial Infarction). Seven of the patients were female, and 14 were male. They presented to an emergency room of a rural hospital that did not provide emergency percutaneous coronary angioplasty/stenting (PTCA/stenting). The hospital is about 70 minutes from a facility that provided PTCA/ stenting—all the patients presented with typical angina chest pain with ST elevation. They are hemodynamic stable. Most patients received Lopressor 35 mg IVP, with one receiving 115 mg in a 5 mg increment. They were chest pain-free and hemodynamically before leaving the ER for the transfer for PTCA/stent. The results demonstrated that beta-blockers are effective in relieving pain in STEMI patients. Further study is needed to determine its efficacy, safety, and how to use it.
文摘Background: Depression and ischemic heart disease (IHD) are associated with persistent stress and autonomic nervous system (ANS) dysfunction. The former can be measured by pressure pain sensitivity (PPS) of the sternum, and the latter by the PPS and systolic blood pressure (SBP) response to a tilt table test (TTT). Beta-blocker treatment reduces the efferent beta-adrenergic ANS function, and thus, the physiological stress response. Objective: To test the effect of beta-blockers on changes in depression score in patients with IHD, as well as the influence on persistent stress and ANS dysfunction. Methods: Three months of non-pharmacological intervention aiming at reducing PPS and depression score in patients with stable IHD. Beta-blocker users (N = 102) were compared with non-users (N = 75), with respect to signs of depression measured by the Major Depressive Inventory questionnaire (MDI), resting PPS, and PPS and SBP response to TTT. Results: MDI score decreased 30% in non-users (p = 0.005) compared to 4% (p > 0.1) among users (between-group p = 0.003;effect size = 0.4). Resting PPS decreased in both the groups. Among most vulnerable patients with MDI ≥ 15, reductions in MDI score and resting PPS score correlated in non-users, only (r = 0.69, p = 0.007). Reduction in resting PPS correlated with an increase in PPS and SBP response to TTT. Conclusions: Stress intervention in patients with IHD was anti-depressive in non-users, only. Similarly, the association between the reduction in depression, reduction in persistent stress, and restoration of ANS dysfunction was only seen in non-users, suggesting a central role of beta-adrenergic receptors in the association between these factors.
文摘Ivabradine,a selective inhibitor of the funny current in the sinoatrial node,has emerged as a promising agent for heart rate modulation in acute and critical care settings.Unlike beta-blockers,ivabradine reduces heart rate without affecting myocardial contractility,making it a valuable option for patients contraindicated for traditional therapies.This review examines its mechanism of action,clinical applications,comparative efficacy,and safety profile.It incorporates recent literature to assess its expanding role in managing acute coronary syndrome,acute decompensated heart failure,and sepsis-induced tachycardia.
文摘Objective To investigate the effects of ascites grading and the application of non-selective beta-blockers(NSBBs)on the 1-year prognosis of acute-on-chronic liver failure(ACLF).Methods 1386 ascitic cases with ACLF were graded and followed up for one year.The 1-year prognostic effect of ascites grade and NSBBs was analyzed on ACLF by the Kaplan Meier Log-rank test,Cox stepwise regression,and multivariate regression.The t-test,Mann-Whitney U,or Kruskal-Wallis test were used for intergroup comparison of measurement data.The X test was used for intergroup comparison of numerical data.Results The incidence rate of ascites at admission was 77.56%in1386ACLFcases.The Log-rank(Mantel-Cox)of the 1-year survival curve test for 1386 ACLF patients with ascites grade was 21.384,P<0.01.Multivariate regression and Cox stepwise regression analysis showed that ascites grade,age,gastrointestinal bleeding,pulmonary infection,acute kidney injury,prothrombin activity(PTA),urea,MELD-Na score,and the use of NSBBs were closely related to the 1-year prognosis of ACLF.The log rank(Mantel-Cox)of NSBBs treatment in the grade 2/3 ascites group was 6.113,P=0.013,and the difference was statistically significant,suggesting that NSBBs treatment can help improve the 1-year survival rate in ACLF patients with grade 2 and 3 ascites.Conclusion Ascites grading and the use of NSBBs affect the prognostic factor of ACLF at one year.NSBBs may be beneficial for the long-term prognosis of ACLF,and treatment can be continued in patients who have already received NSBBs prior to the onset of ACLF.
文摘目的:分析选择性β_(1)受体阻滞剂治疗高血压的有效性和安全性,进一步更新选择性β_(1)受体阻滞剂的循证医学证据。方法:计算机检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Embase、Cochrane Library,搜集关于选择性β_(1)受体阻滞剂治疗高血压患者的随机对照试验,检索时间均为建库至2024年5月。由两名研究者独立进行文献进行筛选、提取资料并评估纳入研究的偏倚风险,采用Cochrane偏倚风险工具对纳入研究进行质量评价,采用R4.4.0软件进行网状Meta分析,计算各结局指标的累积排序概率图下面积(the surface under the cumulative ranking,SUCRA)以比较不同干预措施的有效性与安全性。结果:SUCRA值排序结果显示,在降低收缩压方面:比索洛尔(79.33%)>阿替洛尔(57.46%)>美托洛尔缓释剂(51.12%)>美托洛尔速释剂(12.08%);降低舒张压方面:压比索洛尔(77.38%)>阿替洛尔(65.63%)>美托洛尔缓释剂(51.41%)>美托洛尔速释剂(5.57%);降低24 h动态收缩压方面:比索洛尔(92.44%)>美托洛尔速释剂(54.09%)>美托洛尔缓释剂(52.47%)>阿替洛尔(1.01%);降低24 h动态舒张压方面:比索洛尔(95.24%)>美托洛尔速释剂(52.52%)>美托洛尔缓释剂(46.82%)>阿替洛尔(5.4%);降低心率幅度方面:比索洛尔(97.88%)>阿替洛尔(66.98%)>美托洛尔缓释剂(22.72%)>美托洛尔速释剂(12.42%);降低24 h动态心率方面:美托洛尔缓释剂(69.49%)>比索洛尔(54.97%)>阿替洛尔(39.39%)>美托洛尔速释剂(36.17%);不良反应发生率方面:阿替洛尔(81.38%)>美托洛尔缓释剂(54.86%)>比索洛尔(48.97%)>美托洛尔速释剂(14.79%)。结论:比索洛尔、阿替洛尔、美托洛尔速释剂和美托洛尔缓释剂治疗高血压时均有明显的有效性,其中比索洛尔的有效性最为显著,而阿替洛尔的总不良反应发生率较高,临床使用时应给予关注。
