Abstract 184: Self-reported Hypertension Treatment Practices Among Primary Care Physicians and Cardiologists

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Brent Egan ◽  
John Flack ◽  
Sofia Lombera ◽  
Mehul Patel
Keyword(s):  
Primary Care ◽  
Heart Rate ◽  
Weight Gain ◽  
Primary Care Physicians ◽  
Performance Metrics ◽  
Heart Rate Reduction ◽  
Hypertension Treatment ◽  
Rate Reduction ◽  
Β Blocker ◽  
Β Blockers

Objectives: This study was conducted to examine perceptions, knowledge, and rationale for prescribing β-blockers among physicians who treat patients with hypertension. Methods: In August/September 2016, 103 primary care physicians (PCPs) and 59 cardiologists participated in a 20-minute quantitative, online survey regarding their use and perceptions of β-blockers. Significant between-group differences were examined via t-tests and z-tests. Results: Significantly more cardiologists chose β-blockers as first-line therapy than PCPs (30% vs 17%, P <0.01). Metoprolol and carvedilol were the most commonly prescribed β-blockers. When choosing a β-blocker, cardiologists rated “impact on fatigue and energy” and “arterial vasodilation” as more important treatment features than PCPs ( P <0.05 and P <0.01, respectively). Physicians’ awareness of vasodilation was greater for carvedilol (52% [84/162]) than nebivolol (31%[51/162]). A large proportion of cardiologists and PCPs were unaware that any β-blockers cause weight gain (cardiologists, 34%[20/59]; PCPs, 39%[40/103]) or increased glucose (42% each, cardiologists [25/59], PCPs [43/103]). Overall, physicians associated atenolol and metoprolol with weight gain and clinically relevant changes in glucose, while nebivolol was least associated with either outcome. Only 10% of cardiologists (6/59) and 2% of PCPs (2/103) associated carvedilol with weight gain ( P <0.05). Among β-blocker features, nebivolol was closely associated with: β 1 -selectivity; efficacy in patients aged >60 years; efficacy in African-American patients; and arterial vasodilation. Metoprolol was closely associated with heart rate reduction, and atenolol was associated with heart rate reduction, fatigue, erectile dysfunction, and impact on mood. Physicians had a positive response to using drugs other than metoprolol or atenolol that could lower the risk of new onset diabetes for pre-diabetic or obese patients. Clinical practice guidelines influenced prescribing behaviors more than formulary or performance metrics; continuing medical education and publications were commonly accessed materials for hypertension education. Conclusions: This survey highlights several educational gaps, including differences between PCPs and cardiologists, on the perceptions of β-blockers for hypertension treatment. Future efforts should include physician education on relevant evidence-based differences between β-blockers, given their heterogeneity.

scholarly journals Efficacy of Ivabradine versus β-Blockers for Heart Rate Reduction during Computed Tomography Coronary Angiography: A Meta-Analysis of Randomized Controlled Trials

Cardiology ◽  
2016 ◽  
Vol 135 (3) ◽  
pp. 133-140 ◽  
Author(s):  
Shuang Qiu ◽  
Shaobo Shi ◽  
Haiqin Ping ◽  
Sanfeng Zhou ◽  
Hui Wang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Heart Rate ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Heart Rate Reduction ◽  
Rate Reduction ◽  
Randomized Controlled ◽  
Β Blocker ◽  
The Mean ◽  
Β Blockers

Objective: To quantify the efficacy of pretreatment with ivabradine compared to β-blockers before computed tomography coronary angiography (CTCA) via a meta-analysis of clinical randomized controlled trial data. Methods: We conducted a search for randomized controlled trials of pretreatment with ivabradine compared to β-blockers before CTCA in Medline, PubMed, Embase, SCI/SSCI/A&amp;HCI, SAS Publishers, Web of Science, and the Cochrane Central Register. The Jadad quality score of the included studies, and the mean difference (MD) in heart rate reduction, were indicators of efficacy. RevMan 5.2 and Stata 12.0 software were used for the meta-analysis. Results: Eight studies involving a total of 1,324 patients were included in the final analysis. The results showed that ivabradine was significantly more effective at improving the heart rate of patients achieving the target heart rate (<65 bpm) during CTCA (OR 5.02; 95% CI 3.16-7.98, p < 0.00001, I2 = 20%). A comparison of efficacy between ivabradine and β-blockers showed a statistically significant effect of ivabradine on heart rate reduction during CTCA (MD -4.39; 95% CI −4.80 to −3.99, p < 0.00001, I2 = 0%). Ivabradine also led to a significant reduction in heart rate prior to CTCA (MD −5.33; 95% CI −10.26 to −0.39, p = 0.03, I2 = 92%). In terms of the total reduction in heart rate during CTCA, significant differences were noted between the ivabradine group and the β-blocker group (MD 2.64; 95% CI 1.25-4.02, p = 0.0002, I2 = 0%). The mean percentage reduction in heart rate in the ivabradine group was significantly higher than that in the β-blocker group (MD 7.18; 95% CI 5.64-8.72, p < 0.00001, I2 = 43%). Ivabradine had no significant effect on either systolic blood pressure (BP) (MD 11.41; 95% CI 6.43-16.40, p < 0.00001, I2 = 85%) or diastolic BP (MD 1.79; 95% CI -0.00 to 3.58, p = 0.05, I2 = 56%). Conclusion: Compared to β-blockers for heart rate reduction, ivabradine is a potentially attractive alternative for patients undergoing CTCA.

β-blockers in heart failure—Much more than heart rate reduction

2002 ◽  
Vol 8 (6) ◽  
pp. 379-380 ◽  
Author(s):  
Stephan von Haehling ◽  
Stefan D. Anker
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Heart Rate Reduction ◽  
Rate Reduction ◽  
Β Blockers

Role of Heart Rate Reduction in the Management of Myocarditis

2018 ◽  
Vol 24 (3) ◽  
pp. 365-378 ◽  
Author(s):  
Chen Guang-Yi ◽  
Ge Li-Sha ◽  
Li Yue-Chun
Keyword(s):  
Heart Rate ◽  
Nitrosative Stress ◽  
Ventricular Remodeling ◽  
Animal Experiments ◽  
Viral Myocarditis ◽  
Protective Effects ◽  
Heart Rate Reduction ◽  
Rate Reduction ◽  
Beneficial Effects ◽  
Biological Technique

The morbidity of myocarditis demonstrates an upward tendency by years, is commonly defined as the inflammation of myocytes and is caused by multiple factors. With the development of the molecular biological technique, great breakthroughs in the diagnosis and understanding of pathophysiological mechanisms of myocarditis have recently been achieved. Several questions remain unresolved, however, including standard treatment approaches to myocarditis, which remain controversial and ambiguous. Heart rate, as an independent risk factor, has been shown to be related to cardiac disease. Recent studies also show that the autonomic nervous system is involved in immunomodulatory myocarditis processes. Heart rate reduction treatment is recommended in myocarditis based on a number of animal experiments and clinical trials. It is possible that heart rate-lowering treatments can help to attenuate the inflammatory response and myocyte injury and reverse ventricular remodeling. However, how to execute the protective effects of heart rate reduction on myocarditis is still not clear. In this review, we discuss the pathogenesis and pathophysiological process of viral myocarditis and propose heart rate lowering as a therapeutic target for myocarditis, especially in light of the third-generation β-blockade carvedilol and funny channel blocker ivabradine. We also highlight some additional beneficial effects of such heart rate reduction agents, including anti-inflammatory, antioxidation, anti-nitrosative stress, anti-fibrosis and antiapoptosis properties.

scholarly journals Heart Rate Reduction Strategy Improves Survival in Children with Severe Dilated Cardiomyopathy

2021 ◽  
Vol 40 (4) ◽  
pp. S122
Author(s):  
R. Adorisio ◽  
E. Mencarelli ◽  
N. Cantarutti ◽  
L. Amato ◽  
M. Ciabattini ◽  
...  
Keyword(s):  
Heart Rate ◽  
Dilated Cardiomyopathy ◽  
Heart Rate Reduction ◽  
Rate Reduction ◽  
Reduction Strategy

Heart rate reduction via selective ‘funny’ channel blockers

2007 ◽  
Vol 7 (2) ◽  
pp. 208-213 ◽  
Author(s):  
A BUCCHI ◽  
A BARBUTI ◽  
M BARUSCOTTI ◽  
D DIFRANCESCO
Keyword(s):  
Heart Rate ◽  
Channel Blockers ◽  
Heart Rate Reduction ◽  
Rate Reduction

scholarly journals Heart rate reduction and exercise performance in recent onset heart failure with reduced ejection fraction: arguments for beta-blocker hypo-response

2015 ◽  
Vol 70 (5) ◽  
pp. 565-572
Author(s):  
Frederik H. Verbrugge ◽  
Jeroen Vrijsen ◽  
Jan Vercammen ◽  
Lars Grieten ◽  
Matthias Dupont ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Beta Blocker ◽  
Exercise Performance ◽  
Heart Rate Reduction ◽  
Rate Reduction ◽  
Reduced Ejection Fraction ◽  
Recent Onset

Cardiac autonomic associations on exercise and ambulatory capacity in individuals with lower-extremity artery disease

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Roque Marcal ◽  
N Cornelis ◽  
R Buys ◽  
I Fourneau ◽  
EG Ciolac ◽  
...  
Keyword(s):  
Heart Rate ◽  
Autonomic Function ◽  
Cardiopulmonary Exercise Test ◽  
Treadmill Test ◽  
Cardiopulmonary Exercise ◽  
Sympathetic Modulation ◽  
Β Blocker ◽  
Β Blockers ◽  
Artery Disease ◽  
Lower Extremity Artery Disease

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): This work was in part supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP #2019/19596-7), and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq #303399/2018-0). OnBehalf Exercise and Chronic Disease Research Laboratory - Bauru, Brazil; Research Group for Cardiovascular Rehabilitation - Leuven, Belgium. INTRODUCTION Lower-extremity artery disease (LEAD) characterized by progressive atherosclerotic build-up in leg arteries is becoming increasingly prevalent, affecting more than 200 million people worldwide. In line with other atherosclerotic disorders, LEAD is often associated with autonomic dysfunction as evidenced by a reduced heart rate variability (HRV). To date, little is known on the impact of cardiac autonomic function on exercise and ambulatory capacity. PURPOSE We aimed to investigate whether autonomic function is associated with ambulatory capacity and exercise capacity in patients with LEAD. METHODS Thirty-four patients (age≥17 years) diagnosed with LEAD (ankle brachial index: ABI ≤ 0.9 and/or 20% decrease after a maximal treadmill test) suffering from intermittent claudication (Rutherford I-III) were recruited in the PROSECO-IC trial. Patients were grouped based on beta-blocker medication (β-blocker and non β-blocker). Intervals between R waves (i-RR) obtained by heart rate (HR) signal were acquired beat-to-beat via a digital telemetry system (Polar®️ H10) during 15 min of supine rest and were used for 5-minute HRV analysis. Time domain indexes (mean i-RR, SNDD, pNN50%), and frequency domains (high frequency band (HF), low frequency (LF, very LF (VLF)) and the ratio (LF/HF). HRV was analyzed in absolute (abs), normalized (nu) and log units (log). Ambulatory capacity was assessed by means of a submaximal treadmill test, graded maximal treadmill test using Gardner protocol (GTM) and 6 minutes walking test (6MWT); exercise capacity was assessed by means of a graded maximal cardiopulmonary exercise test (HR, blood pressure (BP) and peak oxygen uptake (VO2peak)) at resting, 2 minutes, and peak of exercise. RESULTS Pearson test showed that sympathetic modulation indexes were moderate associated with pain free distance in GTM (LF/HF: r = 0.52, p = 0.04), and pain free time in 6MWT (LFlog: r=-0.62, p = 0.01; VLF: r=-0.52, p = 0.04), respectively, in patients without β-blocker. Similar HR associations with HRV (time and frequency domain) were observed during submaximal treadmill test and cardiopulmonary exercise test (p ≤ 0.05). Test-t demonstrated a significantly increased response intra-groups in HR and BP during both tests (p ≤ 0.05). Average BP were positive associated with the earlier stages of the cardiopulmonary test (resting to 2 min) with LFlog (r = 0.70, p= &lt;0.001) in β-blocker while non-β-blocker were associated from 2 min to peak with LFabs (r = 0.67, p= &lt;0.001) and LF/HF (r = 0.52, p = 0.03).  CONCLUSION Sympathetic modulation was correlated with a longer pain free walking capacity in non-β-blockers. Yet, individuals treated by -β-blockers showed an earlier sympathetic modulation through exercise pressor response during the first stages of cardiopulmonary exercise compared to non-β-blockers with LEAD.

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