Cardiovascular and metabolic effects of 48-h glucagon-like peptide-1 infusion in compensated chronic patients with heart failure

2010 ◽  
Vol 298 (3) ◽  
pp. H1096-H1102 ◽  
Author(s):  
Mads Halbirk ◽  
Helene Nørrelund ◽  
Niels Møller ◽  
Jens Juul Holst ◽  
Ole Schmitz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Effects ◽  
Tissue Doppler ◽  
Metabolic Effects ◽  
Left Ventricular Ejection ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

The incretin hormone glucagon-like peptide-1 (GLP-1) and its analogs are currently emerging as antidiabetic medications. GLP-1 improves left ventricular ejection fraction (LVEF) in dogs with heart failure (HF) and in patients with acute myocardial infarction. We studied metabolic and cardiovascular effects of 48-h GLP-1 infusions in patients with congestive HF. In a randomized, double-blind crossover design, 20 patients without diabetes and with HF with ischemic heart disease, EF of 30 ± 2%, New York Heart Association II and III ( n = 14 and 6) received 48-h GLP-1 (0.7 pmol·kg−1·min−1) and placebo infusion. At 0 and 48 h, LVEF, diastolic function, tissue Doppler regional myocardial function, exercise testing, noninvasive cardiac output, and brain natriuretic peptide (BNP) were measured. Blood pressure, heart rate, and metabolic parameters were recorded. Fifteen patients completed the protocol. GLP-1 increased insulin (90 ± 17 pmol/l vs. 69 ± 12 pmol/l; P = 0.025) and lowered glucose levels (5.2 ± 0.1 mmol/l vs. 5.6 ± 0.1 mmol/l; P < 0.01). Heart rate (67 ± 2 beats/min vs. 65 ± 2 beats/min; P = 0.016) and diastolic blood pressure (71 ± 2 mmHg vs. 68 ± 2 mmHg; P = 0.008) increased during GLP-1 treatment. Cardiac index (1.5 ± 0.1 l·min−1·m−2 vs. 1.7 ± 0.2 l·min−1·m−2; P = 0.54) and LVEF (30 ± 2% vs. 30 ± 2%; P = 0.93), tissue Doppler indexes, body weight, and BNP remained unchanged. Hypoglycemic events related to GLP-1 treatment were observed in eight patients. GLP-1 infusion increased circulating insulin levels and reduced plasma glucose concentration but had no major cardiovascular effects in patients without diabetes but with compensated HF. The impact of minor increases in heart rate and diastolic blood pressure during GLP-1 infusion requires further studies. Hypoglycemia was frequent and calls for caution in patients without diabetes but with HF.

Changes in arterial blood pressure and heart rate induced by glucagon-like peptide-1-(7-36) amide in rats

1994 ◽  
Vol 266 (3) ◽  
pp. E459-E466 ◽  
Author(s):  
J. M. Barragan ◽  
R. E. Rodriguez ◽  
E. Blazquez
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Diastolic Blood Pressure ◽  
Arterial Blood Pressure ◽  
Mean Arterial Blood Pressure ◽  
Moderate Increase ◽  
Minimal Effect ◽  
Arterial Blood ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

This study was designed to determine the effects of glucagon-like peptides (GLP) on arterial blood pressure and heart rate. Although glucagon caused a minimal effect and GLP-1-(1-37) produced a moderate increase of both systolic and diastolic blood pressure, GLP-1-(7-36) amide induced the greatest increases in both parameters. Systolic and diastolic blood pressure and heart rate values increased when doses of the peptides were increased. By contrast, GLP-2 did not modify either arterial blood pressure or heart rate values. To determine whether the effects of GLP-1-(7-36) amide were mediated through catecholamines, the rats were pretreated with reserpine, propranolol, or phentolamine before administration of the peptide. In these three experimental groups, GLP-1-(7-36) amide increases mean arterial blood pressure and heart rate to the same level or even greater than that observed in nonpretreated rats. These findings indicate that GLP-1-(7-36) amide significantly increases arterial blood pressure and heart rate and that these effects are not mediated through catecholamines.

Abstract 17638: Systemic Cardiovascular Effects of Intravenous Urocortin 2 and Urocortin 3 in Patients with Heart Failure and Healthy Volunteers

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Colin G Stirrat ◽  
Sowmya Venkatasubramanian ◽  
Tania Pawade ◽  
Andrew Mitchell ◽  
Anoop Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Cardiac Index ◽  
Healthy Volunteers ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Effects ◽  
Peripheral Vascular ◽  
Patients With Heart Failure ◽  
Group A ◽  
Urocortin 3

Introduction: Urocortin 2 (UCN 2) and urocortin 3 (UCN 3) are endogenous peptide hormones with an emerging role in the pathophysiology and treatment of heart failure. For the first time, we examined the systemic cardiovascular effects of both UCN 2 and UCN 3 in healthy volunteers and patients with heart failure. Methods: Seven healthy volunteers (Group A) and nine patients with stable chronic heart failure (Group B, New York Heart Association class II and III, left ventricular ejection fraction <35%) on optimal medical therapy underwent non-invasive oscillometric sphygmomanometry and impedance cardiography during incremental intravenous infusions of sodium nitroprusside (0.15/0.5/1.5 μg/kg/min), UCN 2 (0.16/0.48/1.6 μg/min), UCN 3 (5/15/50 μg/min) and saline placebo in a randomised double blind two-way cross over study. Results: Other than diastolic blood pressure (78 vs 72 mmHg for Group A and B respectively, p<0.05), haemodynamic variables were similar at baseline of each infusion and were unchanged by saline placebo infusion (p>0.05 for all). SNP, UCN2 and UCN 3 infusions increased heart rate and cardiac index, and reduced systolic and diastolic blood pressure and peripheral vascular resistance index (PVRI) in both healthy volunteers and patients with heart failure (p<0.05 for all; see Figure 1). There were no significant differences in the changes in cardiac index or PVRI between healthy volunteers and patients with heart failure during either UCN 2 or UCN 3 infusions (p>0.05). Conclusion: Intravenous UCN 2 and especially UCN 3 increase cardiac output and reduce peripheral vascular resistance. This favourable haemodynamic profile suggests that UCN 2 and UCN 3 hold exciting therapeutic potential for the treatment of acute heart failure.

scholarly journals Evaluation of the Cardiovascular Effects of Clonidine in Neonates Treated for Neonatal Abstinence Syndrome

2018 ◽  
Vol 23 (6) ◽  
pp. 473-478
Author(s):  
Raymond P. Meddock ◽  
Deirdre Bloemer
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Diastolic Blood Pressure ◽  
Neonatal Intensive Care ◽  
Dose Range ◽  
Safety Data ◽  
Cardiovascular Effects ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome

OBJECTIVES Neonatal abstinence syndrome (NAS) is characterized by withdrawal symptoms in neonates exposed to legal or illegal substances in utero, and it is often managed with medications such as opiates, phenobarbital, and clonidine. Clonidine use is increasing, but further safety data regarding its use in neonates are warranted. This study evaluated the effects of clonidine on heart rate and blood pressure in neonates treated for NAS at doses up to 24 mcg/kg/day. METHODS A retrospective review via the electronic medical record of infants at least 35 weeks' gestation treated adjunctively with clonidine for NAS in the neonatal intensive care unit at St Elizabeth was conducted. Heart rate, and systolic and diastolic blood pressure were recorded at baseline, while on different dose ranges of clonidine (small: ≤1.5 mcg/kg per dose every 3 hours; medium: &gt;1.5 to 2 mcg/kg per dose every 3 hours; and large: &gt;2 mcg/kg to 3 mcg/kg per dose every 3 hours), and upon discontinuation. RESULTS A total of 64 infants treated with clonidine for NAS between August 2015 and December 2016 were included. Heart rate decreased in all clonidine dose ranges compared with baseline (average reduction of 7 bpm [CI: −12 to −2], 9 bpm [CI: −16 to −2], and 10 bpm [CI: −18 to −1] for the small, medium, and large dose ranges, respectively; p &lt; 0.0001). Systolic and diastolic blood pressure were not significantly different from baseline when infants were receiving any dose of clonidine, except diastolic blood pressure while on medium–dose range clonidine, where diastolic blood pressure was higher than baseline (p = 0.0128). Increases in systolic and diastolic blood pressure were evident upon discontinuation of clonidine (p &lt; 0.0001 and p = 0.0156, respectively). CONCLUSIONS Clonidine doses up to 24 mcg/kg/day are well tolerated in neonates ≥35 weeks' gestation treated for NAS. Any decreases in heart rate are likely clinically insignificant, and increases in blood pressure upon discontinuing clonidine are mild and may be mitigated further with extended discontinuation protocols. Further trials should be conducted to evaluate the long-term safety of clonidine in this population.

scholarly journals Exploring the relationship between schizophrenia and cardiovascular disease: A genetic correlation and multivariable Mendelian randomization study

2021 ◽  
Author(s):  
Rada R Veeneman ◽  
Jentien M Vermeulen ◽  
Abdel Abdellaoui ◽  
Eleanor Sanderson ◽  
Robyn E Wootton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Diastolic Blood Pressure ◽  
Mendelian Randomization ◽  
Genetic Correlations ◽  
Lipid Levels ◽  
Early Repolarization ◽  
Artery Disease

Importance: Individuals with schizophrenia have a reduced life-expectancy compared to the general population, largely due to an increased risk of cardiovascular disease (CVD). Clinical and epidemiological studies have been unable to fully unravel the nature of this relationship. Objective: Investigate genetic correlations and potential bi-directional effects between liability to schizophrenia and CVD. Design, setting, and participants: We obtained summary-data of genome-wide-association studies of schizophrenia (N=130,644), heart failure (N=977,323), coronary artery disease (N=332,477), systolic and diastolic blood pressure (N=757,601), heart rate variability (N=46,952), QT interval (N=103,331), early repolarization and dilated cardiomyopathy ECG patterns (N=63,700). We computed genetic correlations with linkage disequilibrium score regression and conducted bi-directional Mendelian randomization (MR). With multivariable MR, we investigated whether associations were mediated by smoking, body mass index, physical activity, lipid levels, or type 2 diabetes. To ensure robustness, we applied a range of sensitivity methods. Main outcomes and measures: Schizophrenia, heart failure, coronary artery disease, systolic blood pressure, diastolic blood pressure, heart rate variability, QT interval, early repolarization, dilated cardiomyopathy. Results: Genetic correlations between liability to schizophrenia and CVD were close to zero (-0.02 to 0.04). With MR, we found robust evidence that liability to schizophrenia increases heart failure risk. This effect remained consistent with multivariable MR. There was also evidence that liability to schizophrenia increases early repolarization risk, largely mediated by BMI and lipid levels. Finally, there was evidence that liability to schizophrenia increases heart rate variability, a direction of effect contrasting previous studies. In the other direction, there was weak evidence that higher systolic, but not diastolic, blood pressure increases schizophrenia risk. Conclusions and relevance: Our findings indicate that liability to schizophrenia increases the risk of heart failure, and that this is not mediated by key health behaviours. This is consistent with the notion that schizophrenia is characterised by a systemic dysregulation of the body (including inflammation and oxidative stress) with detrimental effects on the heart. To decrease cardiovascular mortality among schizophrenia patients, priority should lie with optimal treatment and interventions in early stages of psychoses. We also identified early repolarization, currently understudied, as a potential CVD marker among patients with schizophrenia.

scholarly journals The use of a new type of heart rate-controlled training system HeartGo for patients with chronic Heart failure on the pedelec.

2020 ◽  
Author(s):  
Erik B Friedrich ◽  
Guenter Hennersdorf ◽  
Herbert Loellgen ◽  
Helmut Roeder ◽  
Wolfgang Baltes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Pilot Study ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Clinical Data ◽  
Health Benefits ◽  
Left Ventricular Ejection ◽  
Rate Controlled

Summary: Background: The study "HI-Herz.BIKE Saar" (August 2017 - September 2019) examined health benefits and training effects of e-bikes (pedelecs) in patients with moderate chronic heart failure (CHF) from ambulatory heart groups. Method: The presented study is explicitly marked as a pilot study. 10 subjects with CHF NYHA stage II-III and a left ventricular ejection fraction (LVEF) of <=50% were selected. In our study, we are the first to employ the novel HeartGo system which allows for heart rate controlled training on pedelecs via a smartphone app. Training groups were accompanied during bike rides by a medical doctor and a paramedic. No cardiac complications occurred. Every six months, training sessions increased in duration, distance, and target frequency. Parameters measured were frequency behaviour, pedaling and motor load on the pedelec as well as clinical data such as ejection fraction, the biomarker NT-pro BNP, risk factors, arterial blood pressure and ergometric courses. Results: Power tolerance increased by almost 2.5 times, while a discrete decrease of the resting heart rate by 3.7% was observed and pedaling power improved accordingly. Clinical data show significant increases in well-being determined by questionnaire, in ergometric power by 45%, and in the LVEF by 29%. This was paralleld by a significant decrease in the NT-pro BNP value by 27% and in systolic blood pressure by 11%. Body Mass Index (BMI) remained constant at 27 and cholesterol levels showed no significant changes. Conclusions: Pedaling according to this pilot study with its methodological limitations of low numbers was safe and accompanied by significant health benefits in patient with CHF. Moreover, subjects were enthusiastic and satisfied with this form of training. Therefore, pedelec training using the HeartGo system could be a helpful tool in the training process of heart group participants with stable CHF. The results of this pilot study with its methodological weaknesses should be verified in a larger follow-up study. Key words: Pedelec, e-bike, heart rate control, heart failure, physical activity

scholarly journals Effect of the Glucagon-like Peptide-1 Receptor (GLP-1R) Agonists on Autonomic Function in Subjects With Diabetes: a Systematic Review and Meta-analysis.

2021 ◽  
Author(s):  
Carla Greco ◽  
Daniele Santi ◽  
Giulia Brigante ◽  
Chiara Pacchioni ◽  
Manuela Simoni
Keyword(s):  
Heart Rate ◽  
Chronic Treatment ◽  
Autonomic Function ◽  
Meta Analysis ◽  
Low Frequency ◽  
Cochrane Collaboration ◽  
Metabolic Effects ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Autonomic Reflex

Abstract Background. In addition to the metabolic effects in diabetes, glucagon-like peptide 1 receptor (GLP-1R) agonists lead to a small but substantial increase in heart rate (HR). However, the GLP-1R actions on the autonomic nervous system (ANS) in people with diabetes remain still debated. Therefore, this meta-analysis evaluates the effect of GLP-1R agonist chronic treatment on measures of ANS function in people with diabetes. Methods. According to the Cochrane Collaboration and PRISMA statement, we conducted a meta-analysis considering clinical trials in which the autonomic function was evaluated in people with diabetes chronically treated with GLP-1R agonists. The outcomes were the change of ANS function measured by heart rate variability (HRV) and cardiac autonomic reflex tests (CARTs). Results. In the studies enrolled, HR significantly increased after treatment (p<0.001), whereas low frequency/high frequency ratio did not differ (p=0.410); no changes in other measures of HRV were detected. Considering CARTs, only the 30:15 value derived from lying-to-standing test was significantly lower after treatment (p=0.002), but only two studies reported this measurement. No differences in other CARTs outcome were observed. Conclusion. The present meta-analysis confirms the HR increase but seems to exclude an alteration of the sympatho-vagal balance due to chronic treatment with GLP-1R agonists in diabetes, considering the available measures of ANS function.

scholarly journals The effect of glucagon-like peptide-1 receptor agonists on 24-hour ambulatory blood pressure: a meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Patoulias ◽  
A Boulmpou ◽  
C E Papadopoulos ◽  
F Siskos ◽  
K Stavropoulos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Randomized Controlled Trials ◽  
Diastolic Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Abstract Background Hypertension augments overall cardiovascular risk in patients with type 2 diabetes mellitus (T2DM), constituting a major additional burden for diabetic subjects; however, control rates of hypertension remain suboptimal. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), second-line treatment option for diabetics, have revolutionized the field of T2DM therapeutic management due to their pleiotropic effects, while they seem to hold multiple cardiovascular benefits. A few randomized controlled trials (RCTs) evaluated the effect of GLP-1RAs on ambulatory blood pressure (ABP). Ambulatory blood pressure monitoring (ABPM) provides a better method to predict long-term cardiovascular outcomes than office blood pressure. Purpose We sought to determine the effect of GLP-1RAs on ABPM, pooling data from relevant randomized controlled trials (RCTs). Methods We searched 2 major electronic databases, namely PubMed and Cochrane/CENTRAL, along with grey literature sources, for RCTs assessing the effect of various GLP-1RAs on ABP in patients with T2DM. Results After screening of the potentially eligible records, 7 RCTs were finally included in our meta-analysis (4 parallel-group and 3 cross-over). GLP-1RA treatment compared to placebo or active control resulted in a nonsignificant decrease in 24-h systolic blood pressure (MD=−1.57 mm Hg, 95% CI: −4.12 to 0.98, I2=63%) (Figure 1) and in 24-h diastolic blood pressure (MD=1.28 mmHg, 95% CI: −0.31 to 2.87, I2=49%) (Figure 2). No subgroup differences between the various GLP-1RAs were identified. More specifically, it was demonstrated that liraglutide once daily produced a non-significant decrease in 24-h systolic blood pressure (MD=−1.43 mm Hg, 95% CI: −5.24 to 2.38, I2=72%) and a non-significant increase in 24-h diastolic blood pressure (MD=1.47 mm Hg, 95% CI: −1.12 to 4.05, I2=61%), while data concerning the effect of once weekly dulaglutide and twice daily exenatide on ABPM were pooled from one RCT respectively (Figures 1, 2). Conclusions Antidiabetic treatment with GLP-1RAs does not influence either systolic or diastolic ABP in patients with T2DM. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

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