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Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The main side effects of beta-blockers are hypotension, dizziness, and brady-cardia. Fatigue and headaches are also reported. Special attention must be given to fluid retention when beta-blockers are introduced. Patients should be weighed daily.
Resistant Hypertension: Medical Treatment
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Michel Azizi, Laurence Amar, Aurélien Lorthioir, Anne-Marie Madjalian
Specialist advice should be sought at a dedicated tertiary BP clinic if BP remains uncontrolled (3–5). At this stage, a stepwise addition of a beta-blocker (with exception of atenolol), an alpha-blocker and a centrally acting alpha-agonist is preferred (Figure 48.1). Beta-blockers can be used particularly in patients with coronary artery disease, heart failure, arrhythmia or chronic kidney disease (3–5). Direct vasodilators (hydralazine or minoxidil) should be avoided, because they may induce fluid retention and tachycardia (3–5). Dual RAS blockade with ACEI and ARBs or with direct renin inhibitors should not be used (3,4) because such combinations (i) are not effective for lowering BP 47, and (ii) are associated with a higher risk of hyperkalaemia, hypotension and acute renal failure (48).
Chronic Headache Pain
Published in Andrea Kohn Maikovich-Fong, Handbook of Psychosocial Interventions for Chronic Pain, 2019
RuthAnn R. Lester, Eleanor S. Brammer, Allison Gray
The utility of beta-blockers in treating chronic migraine is unclear (Becker, 2017). However, everal beta-blockers such as metoprolol and propranolol are recommended by the American Academy of Neurology Guidelines and are commonly used as first-line therapy in migraine prevention (American Headache Society, 2012). For patients with chronic migraine who have other chronic conditions such as hypertension or anxiety, beta-blockers may be an appropriate option, particularly when other medications (such as onabotulinum toxin A) are not feasible.
Focus on cardiometabolic risk factors
Published in Acta Cardiologica, 2023
Glucagon-like peptide-1 receptor agonists (GLP-1RAs), a group of novel antidiabetic agents, demonstrated beneficial cardiovascular effects in recent large, placebo-controlled randomised clinical trials (RCTs) [18]. In patients with type 2 diabetes mellitus, treatment with GLP-1RAs does not significantly affect the risk for major cardiac arrhythmias [19]. The abnormal composition of the gut microbiota is linked to the pathogenesis and propagation of CVD and CVD risk factors. Nagarajan’s review discussed various aspects of the interaction between the microbiome and the immune system in order to reveal causative links relating dysbiosis and autoimmune diseases with special emphasis on rheumatic heart disease [20]. Hypothyroidism can result in decreased cardiac output, increased systemic vascular resistance, decreased arterial compliance, and atherosclerosis. Subclinical hypothyroidism is a highly prevalent disease worldwide but remains challenging to diagnose. The influence of subclinical thyroid dysfunction on the heart and cardiovascular system has been much less studied, necessitating additional studies [21]. Beta-blockers block are widely prescribed for angina, heart failure and some heart rhythm disorders, and to control blood pressure. In patients with myocardial bridge, beta-blockers have a beneficial effect on left ventricular function [22].
Diverse pharmacological properties, trial results, comorbidity prescribing and neural pathophysiology suggest European hypertension guideline downgrading of beta-blockers is not justified
Published in Blood Pressure, 2022
Murray Esler, Sverre E. Kjeldsen, Atul Pathak, Guido Grassi, Reinhold Kreutz, Giuseppe Mancia
Beyond this clinical trial evidence and in support of beta-blocker prescribing in hypertension, there are other important considerations:Beta-blockers represent a heterogenous class of drugs with regard to both pharmacodynamic and pharmacokinetic properties. Hypertension guidelines do not discriminate sufficiently between different beta-blockers in their use as antihypertensive drugs, despite these diverse properties. Although direct evidence from the head-to-head comparison in RCTs is absent, it seems likely that there will be no class effect (no similar benefit for all beta-blockers).Hypertension is characterised by activation of the sympathetic nervous system (SNS) from early to late phases, which makes beta-blockers an appropriate treatment seen from a pathophysiological viewpoint. This applies in particular to patients with elevated heart rate, which is driven by ongoing SNS activation [23,24].Beta-blockers are widely used for the treatment of diseases comorbid with hypertension, and their use is advisable in approximately 50 different concomitant medical conditions, which are frequent in patients with a chronic BP elevation. Comorbidity-directed prescribing of a beta-blocker in hypertension moves the drug class to first-line prescribing, possibly replacing one or more of the antihypertensive drugs currently given priority in the guidelines.
Antihypertensive and cardioprotective effects of three generations of beta-adrenergic blockers: an historical perspective
Published in Hospital Practice, 2022
Steven G. Chrysant, George S. Chrysant
Lipophilicity and Water Solubility: Lipid soluble (LS) beta-blockers have greater penetration of the central nervous system (CNS) with higher concentrations in the brain tissue than water soluble (WS) beta-blockers [36]. The higher CNS concentration could cause insomnia, wild dreams and fatigue. They have short half lives and wide variations in plasma concentration. In addition, LS beta-blockers because of their CNS penetration have been used for the treatment of migraine headaches and essential tremor. In contrast, the water soluble beta-blockers do not penetrate the CNS are do not cause insomnia and wild dreams and are more reliable, because they are less subject to first pass effect of liver metabolism, since they primarily excreted through the kidneys. Perhaps, due to these attributes, water soluble beta-blockers are more preferable over lipophilic beta-blockers for the treatment of hypertension and CVDs [24]. However, water solubility seems to have not significant effect on duration of action, since the water soluble atenolol has shorter duration of action than the lipid soluble betaxolol [37]. Perhaps other factors could account for the prolonged duration action of betaxolol.