The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic ...The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic shunt(TIPS).Both treatment modalities have demonstrated efficacy;however,each presents distinct challenges and benefits.NSBBs,including propranolol,nadolol,and carvedilol,effectively reduce portal pressure,but are associated with side effects such as bradycardia,hypotension,fatigue,and respiratory issues.Additionally,NSBBs can exacerbate conditions such as refractory ascites,hepatorenal syndrome,and hepatic encephalopathy.In contrast,TIPS effectively reduces the incidence of variceal rebleeding,controlling refractory ascites.However,it is associated with a significant risk of hepatic encephalopathy,shunt dysfunction,and procedurerelated complications including bleeding and infection.The high cost of TIPS,along with the need for regular follow-up and potential re-intervention,poses additional challenges.Furthermore,patient selection for TIPS is critical,as inappropriate candidates may experience suboptimal outcomes.Future studies comparing NSBBs and TIPS should focus on refining the patient selection criteria,enhancing procedural techniques,optimising combination therapies,and conducting long-term outcome studies.Personalised treatment approaches,costeffectiveness analyses,and improved patient education and support are essential for maximising the use of these therapies.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
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
OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with...OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with ejection fraction≤35%and glomerular filtration rate(GFR)≤60 m L/min per 1.73 m^2.We analyzed the relationship between treatment with BB and mortality or cardiovascular events.The mean age of our population was 82.6±4.1 years.Mean ejection fraction was 27.9%±6.5%.GFR was 60-45 m L/min per 1.73 m^2 in 50.3%of patients,45-30 m L/min per 1.73 m^2 in 37.4%,and<30 m L/min per 1.73 m^2 in 12.3%.At the conclusion of follow-up,67.4%of patients were receiving BB.The median follow-up was28.04(IR:19.41-36.67)months.During the study period,211 patients(54.1%)died and 257(65.9%)had a major cardiovascular event(death or hospitalization for heart failure).BB use was significantly associated with a reduced risk of death(HR=0.51,95%CI:0.35-0.74;P<0.001).Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR=30-45 m L/min per 1.73 m^2;HR=0.47,95%CI:0.26-0.86,P<0.0001),stage IIIb(GFR 30-45 m L/min per 1.73 m^2;HR=0.55,95%CI:0.26-1.06,P=0.007),and stages IV and V(GFR<30 m L/min per 1.73 m~2;HR=0.29,95%CI:0.11-0.76;P=0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.展开更多
Objective To investigate the risk factors of symptomatic bradyarrhythrnias in relation to β-blockers use. Methods A hospital-based case-control study [228 patients： 108 with symptomatic bradyarrhythmias （cases） an...Objective To investigate the risk factors of symptomatic bradyarrhythrnias in relation to β-blockers use. Methods A hospital-based case-control study [228 patients： 108 with symptomatic bradyarrhythmias （cases） and 120 controls] was conducted in Sultanah Aminah Hospital, Malaysia between January 2011 and January 2014. Results The mean age was 61.1 ~ 13.3 years with a majority of men （68.9%）. Cases were likely than control to be older, hypertensive, lower body mass index and concomitant use of rate-controlling drugs （such as digoxin, verapamil, diltiazem, ivabradine or amiodarone）. Significantly higher level of serum potassium, urea, creatinine and lower level of estimated glomerular filtration rate （eGFR） were observed among cases as compared to controls. On univariate analysis among patients on β-blockers, older age （crude OR： 1.07; 95% CI： 1.03-1.11, P = 0.000）, hypertension （crude OR： 5.6; 95% CI： 1.51-20.72, P = 0.010）, lower sodium （crude OR： 0.04; 95% CI： 0.81-0.99, P = 0.036）, higher potassium （crude OR： 2.36; 95% CI： 1.31-4.26, P = 0.004） and higher urea （crude OR： 1.23; 95% CI： 1.11-1.38, P = 0.000） were associated with increased risk of symptomatic bradyarrhythmias; eGFR was inversely and significantly associated with symptomatic bradyarrhythmias in both ＇β-blockers＇ （crude OR： 0.97; 95% CI： 0.964）.98, P = 0.000） and ＇non-β-blockers＇ （crude OR： 0.99; 95% CI： 0.97-0.99, P = 0.023） arms. However, eGFR was not significantly associated with symptomatic bradyarrhythmias in the final model of both ＇β-blockers＇ （adjusted OR： 0.98; 95% CI： 0.96-0.98, P = 0.103） and ＇non-p-blockers＇ （adjusted OR： 0.99; 95% CI： 0.97-1.01, P = 0.328） arms. Importantly, older age was a significant predictor of symptomatic bradyarrhythmias in the ＇β-blockers＇ as compared to the ＇non-β-blockers＇ arms （adjusted OR： 1.09; 95% CI： 1.03-1.15, P = 0.003 vs. adjusted OR： 1.03; 95% CI： 0.98-1.09, P = 0.232, respectively）. Conclusion Older age was a significant predictor of symptomatic bradyarrhythmias in patients on β-blockers than those without β-blockers.展开更多
OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ej...OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)level.METHODS We enrolled hospitalized HF patients with AF from China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study.COX proportional hazard regression models were employed to calculate hazard ratio of betablockers.The primary outcome was all-cause death.RESULTS Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire cohort.There were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite outcome.In the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(<40%),mid-range(40%-49%),or preserved LVEF(≥50%).CONCLUSION Among HF patients with AF,the use of beta-blockers at discharge was not associated with 1-year clinical outcomes,regardless of LVEF.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
1 Introduction Beta-adrenoceptor blocking agents(beta-blockers)are now well established as cornerstone therapy in patients with systolic chronic heart failure(CHF).[1]Clinical data have overwhelmingly proven the benef...1 Introduction Beta-adrenoceptor blocking agents(beta-blockers)are now well established as cornerstone therapy in patients with systolic chronic heart failure(CHF).[1]Clinical data have overwhelmingly proven the beneficial effects of beta-blocker therapy in terms of improving patient prognosis,decreasing requirements for hospitalization,and postponing disease progression.[2-4]However,it remains unclear what the optimal efficacious and safe dose for an individual patient with CHF is,and whether this can simply be inferred from the target dose for each beta-blocking agent as used in the major clinical trials.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
A retiabte and sensitive method is developed for the detection of β-blockers which are excreted in free or conjugated forms in human urine.9 β-blockers were derivatized by MSTFA and MBTFA and subjected to GC/MSB ana...A retiabte and sensitive method is developed for the detection of β-blockers which are excreted in free or conjugated forms in human urine.9 β-blockers were derivatized by MSTFA and MBTFA and subjected to GC/MSB analysis.Both chromato- grams and mass spectrometric data were obtained from full scanning mode.This method is suitable for routine screening and confirmation of β-blockers in doping control.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:Beta-adrenergic receptor blockers are conventionally used for the treatment of hypertension,tachycardia,and glaucoma.Research has shown that beta-blockers can accelerate wound epithelialization.In this study,we te...Aim:Beta-adrenergic receptor blockers are conventionally used for the treatment of hypertension,tachycardia,and glaucoma.Research has shown that beta-blockers can accelerate wound epithelialization.In this study,we tested the efficacy of the beta-blocker timolol in an ovine model of grafted full-thickness burn wound healing,which closely mimics clinical scenarios.Methods:Six full-thickness burn wounds were created on the sheep’s posterior surface.Twenty-four hours later,eschars were excised and meshed skin was grafted(Day0).The wounds in the treatment group received topical application of timolol.Blood flow was measured using a blood perfusion imager.Cardiovascular hemodynamics and blood glucose levels were recorded daily.The epithelialization rate on Day 14 was determined by planimetric assay and analyzed by paired t-test.The days that the epithelialization rate exceeded 85%,90%,and 95%were analyzed by survival analysis.To assess the potential influence of TGFβ,epithelial-mesenchymal transition(EMT),or myofibroblast activation(MFA)on wound healing,the RNA abundance of gene products related to these Results:The epithelialization rate on Day 14 was significantly higher in the treatment group.The days that the epithelialization rate exceeded 85%,90%,and 95%were significantly shorter in the treatment group.There was no significant difference in wound blood flow or RNA abundance related to TGFβ,EMT,or MFA-related pathways among the groups at any time point.Conclusion:The results demonstrate that the beta-blocker timolol accelerates epithelialization of mesh skin grafted full-thickness burn wounds through a mechanism other than improving wound blood flow.展开更多
Background The importance of heart rate as secondary prevention strategies for patients with coronary artery disease （CAD） is emphasized by multiple guidelines. However, limited information is available on the heart...Background The importance of heart rate as secondary prevention strategies for patients with coronary artery disease （CAD） is emphasized by multiple guidelines. However, limited information is available on the heart rate distribution and the change patterns of resting heart rate when initiating beta-blocker therapy among Chinese patients with CAD. Methods The REsults of Sympathetic Evaluation And Research of China （RESEARCH） study is a multi-centre, prospective, observational study involving 147 centers in 23 cities across China. All eligible beta-blocker naive patients were prescribed with metroprolol succinate. Initial dosage and target heart rate were selected at the discretion of their physicians in charge according to their usual institutional practice. The heart rate distribution and the change patterns of resting heart rate after initiation of beta-blocker therapy were observed. Results The majority of patients （63.6%） were prescribed with 47.5 mg metroprolol succinate. At baseline, there were only 17.4% of patients whose heart rate was less than 70 beats per minute, and the proportion reached 42.5% and 79.1%, one month and two months after initiation of beta-blockers, respectively. Multivariate linear regression analysis showed that baseline heart rate （B=0.900, SE=0.006, t=141.787, P〈0.0001） and the dosage （B=-0.007, SE=0.002, t=-3.242, P=0.001） were independent predictors of resting heart rate 2 months after beta-blocker therapy. Conclusions Resting heart rate is not optimally controlled in a broadly representative cohort of Chinese outpatients with CAD even after initiation of β-blocker therapy, and baseline heart rate and the dosage of beta-blocker are both independent predictors of resting heart rate after β-blocker therapy.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The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic shunt(TIPS).Both treatment modalities have demonstrated efficacy;however,each presents distinct challenges and benefits.NSBBs,including propranolol,nadolol,and carvedilol,effectively reduce portal pressure,but are associated with side effects such as bradycardia,hypotension,fatigue,and respiratory issues.Additionally,NSBBs can exacerbate conditions such as refractory ascites,hepatorenal syndrome,and hepatic encephalopathy.In contrast,TIPS effectively reduces the incidence of variceal rebleeding,controlling refractory ascites.However,it is associated with a significant risk of hepatic encephalopathy,shunt dysfunction,and procedurerelated complications including bleeding and infection.The high cost of TIPS,along with the need for regular follow-up and potential re-intervention,poses additional challenges.Furthermore,patient selection for TIPS is critical,as inappropriate candidates may experience suboptimal outcomes.Future studies comparing NSBBs and TIPS should focus on refining the patient selection criteria,enhancing procedural techniques,optimising combination therapies,and conducting long-term outcome studies.Personalised treatment approaches,costeffectiveness analyses,and improved patient education and support are essential for maximising the use of these therapies.
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OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with ejection fraction≤35%and glomerular filtration rate(GFR)≤60 m L/min per 1.73 m^2.We analyzed the relationship between treatment with BB and mortality or cardiovascular events.The mean age of our population was 82.6±4.1 years.Mean ejection fraction was 27.9%±6.5%.GFR was 60-45 m L/min per 1.73 m^2 in 50.3%of patients,45-30 m L/min per 1.73 m^2 in 37.4%,and<30 m L/min per 1.73 m^2 in 12.3%.At the conclusion of follow-up,67.4%of patients were receiving BB.The median follow-up was28.04(IR:19.41-36.67)months.During the study period,211 patients(54.1%)died and 257(65.9%)had a major cardiovascular event(death or hospitalization for heart failure).BB use was significantly associated with a reduced risk of death(HR=0.51,95%CI:0.35-0.74;P<0.001).Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR=30-45 m L/min per 1.73 m^2;HR=0.47,95%CI:0.26-0.86,P<0.0001),stage IIIb(GFR 30-45 m L/min per 1.73 m^2;HR=0.55,95%CI:0.26-1.06,P=0.007),and stages IV and V(GFR<30 m L/min per 1.73 m~2;HR=0.29,95%CI:0.11-0.76;P=0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.
文摘Objective To investigate the risk factors of symptomatic bradyarrhythrnias in relation to β-blockers use. Methods A hospital-based case-control study [228 patients： 108 with symptomatic bradyarrhythmias （cases） and 120 controls] was conducted in Sultanah Aminah Hospital, Malaysia between January 2011 and January 2014. Results The mean age was 61.1 ~ 13.3 years with a majority of men （68.9%）. Cases were likely than control to be older, hypertensive, lower body mass index and concomitant use of rate-controlling drugs （such as digoxin, verapamil, diltiazem, ivabradine or amiodarone）. Significantly higher level of serum potassium, urea, creatinine and lower level of estimated glomerular filtration rate （eGFR） were observed among cases as compared to controls. On univariate analysis among patients on β-blockers, older age （crude OR： 1.07; 95% CI： 1.03-1.11, P = 0.000）, hypertension （crude OR： 5.6; 95% CI： 1.51-20.72, P = 0.010）, lower sodium （crude OR： 0.04; 95% CI： 0.81-0.99, P = 0.036）, higher potassium （crude OR： 2.36; 95% CI： 1.31-4.26, P = 0.004） and higher urea （crude OR： 1.23; 95% CI： 1.11-1.38, P = 0.000） were associated with increased risk of symptomatic bradyarrhythmias; eGFR was inversely and significantly associated with symptomatic bradyarrhythmias in both ＇β-blockers＇ （crude OR： 0.97; 95% CI： 0.964）.98, P = 0.000） and ＇non-β-blockers＇ （crude OR： 0.99; 95% CI： 0.97-0.99, P = 0.023） arms. However, eGFR was not significantly associated with symptomatic bradyarrhythmias in the final model of both ＇β-blockers＇ （adjusted OR： 0.98; 95% CI： 0.96-0.98, P = 0.103） and ＇non-p-blockers＇ （adjusted OR： 0.99; 95% CI： 0.97-1.01, P = 0.328） arms. Importantly, older age was a significant predictor of symptomatic bradyarrhythmias in the ＇β-blockers＇ as compared to the ＇non-β-blockers＇ arms （adjusted OR： 1.09; 95% CI： 1.03-1.15, P = 0.003 vs. adjusted OR： 1.03; 95% CI： 0.98-1.09, P = 0.232, respectively）. Conclusion Older age was a significant predictor of symptomatic bradyarrhythmias in patients on β-blockers than those without β-blockers.
基金supported by the National Key Research and Development Program from the Ministry of Science and Technology of China(grant number:2018YFC1312400)the CAMS Innovation Fund for Medical Science(grant number:2016-I2M-2-004,2017-I2M-2-002)+1 种基金the National Key Technology R&D Program from the Ministry of Science and Technology of China(grant number:2015BAI12B02)the 111 Project from the Ministry of Education of China(grant number:B16005)。
文摘OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)level.METHODS We enrolled hospitalized HF patients with AF from China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study.COX proportional hazard regression models were employed to calculate hazard ratio of betablockers.The primary outcome was all-cause death.RESULTS Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire cohort.There were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite outcome.In the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(<40%),mid-range(40%-49%),or preserved LVEF(≥50%).CONCLUSION Among HF patients with AF,the use of beta-blockers at discharge was not associated with 1-year clinical outcomes,regardless of LVEF.
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1 Introduction Beta-adrenoceptor blocking agents(beta-blockers)are now well established as cornerstone therapy in patients with systolic chronic heart failure(CHF).[1]Clinical data have overwhelmingly proven the beneficial effects of beta-blocker therapy in terms of improving patient prognosis,decreasing requirements for hospitalization,and postponing disease progression.[2-4]However,it remains unclear what the optimal efficacious and safe dose for an individual patient with CHF is,and whether this can simply be inferred from the target dose for each beta-blocking agent as used in the major clinical trials.
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A retiabte and sensitive method is developed for the detection of β-blockers which are excreted in free or conjugated forms in human urine.9 β-blockers were derivatized by MSTFA and MBTFA and subjected to GC/MSB analysis.Both chromato- grams and mass spectrometric data were obtained from full scanning mode.This method is suitable for routine screening and confirmation of β-blockers in doping control.
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support for Nakamoto K,Batsaikhan TA,Kakizaki R,Heathman T,and Enkhbaatar P was National Institutes of Health GM097480.
文摘Aim:Beta-adrenergic receptor blockers are conventionally used for the treatment of hypertension,tachycardia,and glaucoma.Research has shown that beta-blockers can accelerate wound epithelialization.In this study,we tested the efficacy of the beta-blocker timolol in an ovine model of grafted full-thickness burn wound healing,which closely mimics clinical scenarios.Methods:Six full-thickness burn wounds were created on the sheep’s posterior surface.Twenty-four hours later,eschars were excised and meshed skin was grafted(Day0).The wounds in the treatment group received topical application of timolol.Blood flow was measured using a blood perfusion imager.Cardiovascular hemodynamics and blood glucose levels were recorded daily.The epithelialization rate on Day 14 was determined by planimetric assay and analyzed by paired t-test.The days that the epithelialization rate exceeded 85%,90%,and 95%were analyzed by survival analysis.To assess the potential influence of TGFβ,epithelial-mesenchymal transition(EMT),or myofibroblast activation(MFA)on wound healing,the RNA abundance of gene products related to these Results:The epithelialization rate on Day 14 was significantly higher in the treatment group.The days that the epithelialization rate exceeded 85%,90%,and 95%were significantly shorter in the treatment group.There was no significant difference in wound blood flow or RNA abundance related to TGFβ,EMT,or MFA-related pathways among the groups at any time point.Conclusion:The results demonstrate that the beta-blocker timolol accelerates epithelialization of mesh skin grafted full-thickness burn wounds through a mechanism other than improving wound blood flow.
文摘Background The importance of heart rate as secondary prevention strategies for patients with coronary artery disease （CAD） is emphasized by multiple guidelines. However, limited information is available on the heart rate distribution and the change patterns of resting heart rate when initiating beta-blocker therapy among Chinese patients with CAD. Methods The REsults of Sympathetic Evaluation And Research of China （RESEARCH） study is a multi-centre, prospective, observational study involving 147 centers in 23 cities across China. All eligible beta-blocker naive patients were prescribed with metroprolol succinate. Initial dosage and target heart rate were selected at the discretion of their physicians in charge according to their usual institutional practice. The heart rate distribution and the change patterns of resting heart rate after initiation of beta-blocker therapy were observed. Results The majority of patients （63.6%） were prescribed with 47.5 mg metroprolol succinate. At baseline, there were only 17.4% of patients whose heart rate was less than 70 beats per minute, and the proportion reached 42.5% and 79.1%, one month and two months after initiation of beta-blockers, respectively. Multivariate linear regression analysis showed that baseline heart rate （B=0.900, SE=0.006, t=141.787, P〈0.0001） and the dosage （B=-0.007, SE=0.002, t=-3.242, P=0.001） were independent predictors of resting heart rate 2 months after beta-blocker therapy. Conclusions Resting heart rate is not optimally controlled in a broadly representative cohort of Chinese outpatients with CAD even after initiation of β-blocker therapy, and baseline heart rate and the dosage of beta-blocker are both independent predictors of resting heart rate after β-blocker therapy.
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。
