scholarly journals Comprehensive Comparative Effectiveness and Safety of First-Line β-Blocker Monotherapy in Hypertensive Patients

Hypertension ◽  
2021 ◽  
Vol 77 (5) ◽  
pp. 1528-1538
Author(s):  
Seng Chan You ◽  
Harlan M. Krumholz ◽  
Marc A. Suchard ◽  
Martijn J. Schuemie ◽  
George Hripcsak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Comparative Effectiveness ◽  
Third Generation ◽  
First Line ◽  
The Third ◽  
Empirical Calibration ◽  
Β Blocker ◽  
Β Blockers

Evidence for the effectiveness and safety of the third-generation β-blockers other than atenolol in hypertension remains scarce. We assessed the effectiveness and safety of β-blockers as first-line treatment for hypertension using 3 databases in the United States: 2 administrative claims databases and 1 electronic health record–based database from 2001 to 2018. In each database, comparative effectiveness of β-blockers for the risks of acute myocardial infarction, stroke, and hospitalization for heart failure was assessed, using large-scale propensity adjustment and empirical calibration. Estimates were combined across databases using random-effects meta-analyses. Overall, 118 133 and 267 891 patients initiated third-generation β-blockers (carvedilol and nebivolol) or atenolol, respectively. The pooled hazard ratios (HRs) of acute myocardial infarction, stroke, hospitalization for heart failure, and most metabolic complications were not different between the third-generation β-blockers versus atenolol after propensity score matching and empirical calibration (HR, 1.07 [95% CI, 0.74–1.55] for acute myocardial infarction; HR, 1.06 [95% CI, 0.87–1.31] for stroke; HR, 1.46 [95% CI, 0.99–2.24] for hospitalized heart failure). Third-generation β-blockers were associated with significantly higher risk of stroke than ACE (angiotensin-converting enzyme) inhibitors (HR, 1.29 [95% CI, 1.03–1.72]) and thiazide diuretics (HR, 1.56 [95% CI, 1.17–2.20]). In conclusion, this study found many patients with first-line β-blocker monotherapy for hypertension and no statistically significant differences in the effectiveness and safety comparing atenolol with third-generation β-blockers. Patients on third-generation β-blockers had a higher risk of stroke than those on ACE inhibitors and thiazide diuretics.

In Current Clinical Practice, after Percutaneous Coronary Intervention for Acute Myocardial Infarction, Are β-Blockers Prescribed for Heart Failure or as Secondary Prevention? A Pilot Study

Cardiology ◽  
2018 ◽  
Vol 140 (3) ◽  
pp. 152-154 ◽  
Author(s):  
Vidar Ruddox ◽  
Jan Erik Otterstad ◽  
Dan Atar ◽  
Bjørn Bendz ◽  
Thor Edvardsen
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Pilot Study ◽  
Secondary Prevention ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Β Blocker ◽  
Β Blockers

Objectives: Patients surviving an acute myocardial infarction (AMI) are different today than when oral β-blockers first were shown to have an incremental effect on mortality. They are now, as opposed to then, offered revascularization procedures and effective secondary prevention. In this pilot-study, we aimed to explore the prescription of β-blockers to these patients stratified by their left ventricular ejection fraction (LVEF). Methods: Consecutive stable patients treated with a percutaneous coronary intervention (PCI) procedure following an AMI were included for measurement of LVEF after 1–5 days. β-Blocker treatment was recorded at inclusion and after 3 months. Results: We included 159 patients, 89% with LVEF ≥40% (56% had a LVEF ≥50% [preserved], 33% LVEF 40–49% [mid-range] and 11% LVEF <40% [reduced]). At discharge the prescription rates of β-blockers according to LVEF stratification were 79% for preserved, 79% for mid-range and 94% for reduced LVEF. After 3 months 72% of all patients continued such treatment. Conclusions: In this prospective study, a large proportion of contemporary managed patients with AMI but without clinical heart failure does not have reduced LVEF shortly after PCI, but the majority is still treated with a β-blocker.

Effects of β-Blockers and Anxiety on Complication Rates After Acute Myocardial Infarction

2011 ◽  
Vol 20 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Mohannad E. Abu Ruz ◽  
Terry A. Lennie ◽  
Debra K. Moser
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Length Of Stay ◽  
Brief Symptom Inventory ◽  
Anxiety Score ◽  
Complication Rates ◽  
Main Effect ◽  
Daily Dose ◽  
Β Blocker ◽  
Β Blockers

Background Anxiety is common after acute myocardial infarction and increases the number of complications and the length of stay in the hospital. Anxiety-induced activation of the sympathetic nervous system is hypothesized to be an underlying cause of increased complication rates. Little is known about whether use of β-blockers eliminates the effects of anxiety on complication rate and length of stay. Objective To compare number of complications and length of stay among nonanxious and anxious patients receiving β-blockers during hospitalization. Method A total of 322 patients with acute myocardial infarction participated in this study within 48 hours of hospital admission. Patients completed the Brief Symptom Inventory to assess anxiety level. After discharge, medical records were reviewed to determine use of β-blockers, type and number of complications, and length of stay. Results Most patients (96%) were treated with less than 200 mg daily of metoprolol. Anxious patients had more complications (mean [SD], 1.43 [0.15] vs 0.73 [.09], P = .01) and longer stays (7.0 [0.49] vs 5.7 [0.36] days, P &lt; .05) than did nonanxious patients. To test whether the dose of β-blocker made a difference, the interaction between daily dose and anxiety score was tested. No interaction was found between metoprolol dose and anxiety score, and no main effect was found for metoprolol dose. Conclusion Anxious patients had more complications and longer stays than did nonanxious patients. The administration of metoprolol did not eliminate this relationship, perhaps because patients did not receive a sufficient dose of metoprolol to counter the effect of anxiety.

scholarly journals β-Blockers and Mortality After Acute Myocardial Infarction in Patients Without Heart Failure or Ventricular Dysfunction

2017 ◽  
Vol 69 (22) ◽  
pp. 2710-2720 ◽  
Author(s):  
Tatendashe B. Dondo ◽  
Marlous Hall ◽  
Robert M. West ◽  
Tomas Jernberg ◽  
Bertil Lindahl ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Ventricular Dysfunction ◽  
Β Blockers

scholarly journals Patient-Important Adverse Events of β-blockers in Frail Older Adults after Acute Myocardial Infarction

2018 ◽  
Vol 74 (8) ◽  
pp. 1277-1281 ◽  
Author(s):  
Andrew R Zullo ◽  
Matthew Olean ◽  
Sarah D Berry ◽  
Yoojin Lee ◽  
Jennifer Tjia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Adverse Events ◽  
Multinomial Logistic Regression ◽  
Cognitive Status ◽  
Vulnerable Groups ◽  
Data Set ◽  
Β Blocker ◽  
Β Blockers

Abstract Background We evaluated the burden of adverse events caused by β-blocker use after acute myocardial infarction (AMI) in frail, older nursing home (NH) residents. Methods This retrospective cohort study used national Medicare claims linked to Minimum Data Set assessments. The study population was individuals aged ≥65 years who resided in a U.S. NH for ≥30 days, had a hospitalized AMI between May 2007 and March 2010, and returned to the NH. Exposure was new use of β-blockers versus nonuse post-AMI. Orthostasis, general hypotension, falls, dizziness, syncope, and breathlessness outcomes were measured over 90 days of follow-up. Odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes were estimated using multinomial logistic regression models after 1:1 propensity score-matching of β-blocker users to nonusers. Results Among the 10,992 NH propensity score-matched residents with an AMI, the mean age was 84 years and 70.9% were female. β-blocker users were more likely than nonusers to be hospitalized for hypotension (OR = 1.20, 95% CI 1.03–1.39) or experience breathlessness (OR = 1.10, 95% CI 1.01–1.20) after AMI. With the exception of falls, other outcome estimates, though imprecise, were compatible with a potential elevated risk of orthostasis (OR = 1.14, 95% CI 0.96–1.35), syncope, (OR = 1.24, 95% CI 0.55–2.77), and dizziness (OR = 1.28, 95% CI 0.82–1.99) among β-blocker users. Conclusions Considered alongside prior evidence that β-blockers may worsen functional outcomes in NH residents with poor baseline functional and cognitive status, our results suggest that providers should exercise caution when prescribing for these vulnerable groups, balancing the mortality benefit against the potential for causing adverse events.

scholarly journals Long-term β-blocker therapy and clinical outcomes after acute myocardial infarction in patients without heart failure: nationwide cohort study

2020 ◽  
Vol 41 (37) ◽  
pp. 3521-3529 ◽  
Author(s):  
Jihoon Kim ◽  
Danbee Kang ◽  
Hyejeong Park ◽  
Minwoong Kang ◽  
Taek Kyu Park ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Coronary Revascularization ◽  
Blocker Therapy ◽  
Β Blocker ◽  
Insurance Data

Abstract Aims To investigate the association between long-term β-blocker therapy and clinical outcomes in patients without heart failure (HF) after acute myocardial infarction (AMI). Method and results Between 2010 and 2015, a total of 28 970 patients who underwent coronary revascularization for AMI with β-blocker prescription at hospital discharge and were event-free from death, recurrent myocardial infarction (MI), or HF for 1 year were enrolled from Korean nationwide medical insurance data. The primary outcome was all-cause death. The secondary outcomes were recurrent MI, hospitalization for new HF, and a composite of all-cause death, recurrent MI, or hospitalization for new HF. Outcomes were compared between β-blocker therapy for ≥1 year (N = 22 707) and β-blocker therapy for &lt;1 year (N = 6263) using landmark analysis at 1 year after index MI. Compared with patients receiving β-blocker therapy for &lt;1 year, those receiving β-blocker therapy for ≥1 year had significantly lower risks of all-cause death [adjusted hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.72–0.91] and composite of all-cause death, recurrent MI, or hospitalization for new HF (adjusted HR 0.82; 95% CI 0.75–0.89), but not the risks of recurrent MI or hospitalization for new HF. The lower risk of all-cause death associated with persistent β-blocker therapy was observed beyond 2 years (adjusted HR 0.86; 95% CI 0.75–0.99) but not beyond 3 years (adjusted HR 0.87; 95% CI 0.73–1.03) after MI. Conclusion In this nationwide cohort, β-blocker therapy for ≥1 year after MI was associated with reduced all-cause death among patients with AMI without HF.

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