Thailand Medical News Will Be Providing 3 Daily Updates On the China Coronavirus Epidemic On A Regular Basis

BREAKING NEWS
Source: Thailand Medical News  Dec 05, 2019
High Blood Pressure Beta Blocker Drugs Linked To 74 Percent Increased Risk Of Heart Failure!
Presented by
High Blood Pressure Beta Blocker Drugs Linked To 74 Percent Increased Risk Of Heart Failure!
Source: Thailand Medical News  Dec 05, 2019
The incidence of heart failure globally is about 39.4 million cases per year and is a leading driver of health care costs in the world. The "stiff heart" heart failure variant accounts for about half of all cases and the vast majority of such patients take beta-blocker medications despite unclear benefit from their regular use. A new medical publication in JAMA ( The Journal of the American Medical Association Network Open  (4 hours ago) links use of beta-blockers to heart failure hospitalizations among those with this common "stiff heart" heart failure subtype.



Typically, heart failure occurs when the heart cannot meet the body's demands. About half of patients have heart failure characterized by a normal squeeze but impaired relaxation of the heart muscle from a "stiff heart". This is also known as heart failure with preserved ejection fraction. The other half of cases are due to a "weak heart" with an abnormal squeeze, also known as heart failure with reduced ejection fraction. Beta-blockers ie medications that lower the heart rate and blood pressure are strongly recommended in national guidelines for treatment of "weak heart" heart failure because of their clear benefit. Beta blockers are prescribed to about 80% of patients suffering from high blood pressure or hypertension. The global incidence rate of people suffering from high blood pressure was about 974 million in 2017!

Dr Timothy Plante, M.D., an assistant professor of medicine at the Larner College of Medicine at the University of Vermont and coauthor, told Thailand Medical News in a phone interview, "A big problem with 'stiff heart' heart failure is that we don't have effective medical therapies. So, instead, we use the same medications that work for 'weak heart' heart failure. Because beta-blockers save lives in 'weak heart' heart failure, we assume they are also effective in 'stiff heart' heart failure patients this assumption may be wrong."

Dr Plante, lead author Dr Daniel Silverman, M.D., senior author Markus Meyer, M.D., and colleagues analyzed data from the National Institutes of Health-funded TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) study, a trial of the medication spironolactone in patients with "stiff heart" heart failure. About four out of five study participants were on beta-blockers.

The cardio researchers found beta-blocker use to be a risk factor for hospitalizations for heart failure among these patients with "stiff heart" heart failure.

Dr Meyer, an associate professor of medicine at the University of Minnesota Medical School warned, "Beta-blocker use was associated with a 74 percent higher risk of heart failure hospitalizations among participants with heart failure and a normal pump function."

Although they are being used commonly, the authors note that beta-blocker use in "stiff heart" heart failure has not been sufficiently studied. This publication extends their prior work, which found that halting beta-blockers markedly improves levels of the heart failure blood test known as BNP among patients with "stiff heart" heart failure.

Dr Silverman, a cardiology fellow and clinical instructor in medicine at the University of Vermont Medical Center and Larner College of Medicine said,  "In 'stiff heart' heart failure, the heart is less able to relax and fill with blood. Beta-blockers appear to increase pressures inside the heart. This may lead to symptoms like worsening shortness of breath and retention of fluid.

Even people without heart failure will have more shortness of breath and less exercise capacity. This has been a known class side effect for decades. It is important to understand that our findings are not proof that beta-blockers are harmful among patients with 'stiff heart' heart failure, it is just a concerning signal."

The researchers  believe their findings warrant a clinical trial to evaluate the safety and effects of beta-blockers in patients with "stiff heart" heart failure. "There are some big next steps, like reproducing this finding in other studies and testing if there is a benefit of stopping beta-blockers in patients with 'stiff heart' heart failure," says Silverman.

Thailand Medical News advises that high blood pressure patients currently on beta-blockers not to stop using any of their drugs on their own as this is extremely dangerous. Rather they should immediately make appointments to see their doctors to seek alternative drugs to switch to. Never self prescribe or make any make any changes to your medical care without consulting a licensed and well informed doctor. Examples of beta blockers include: 
 
  • Acebutolol (Sectral)
  • Atenolol (Tenormin)
  • Betaxolol (Kerlone)
  • Bisoprolol (Zebeta, Ziac)
  • Carteolol (Cartrol)
  • Carvedilol (Coreg)
  • Labetalol (Normodyne, Trandate)
  • Metoprolol (Lopressor, Toprol-XL)
  • Nadolol (Corgard)
  • Nebivolol (Bystolic)
  • Penbutolol (Levatol)
  • Pindolol (Visken)
  • Propanolol (Inderal)
  • Sotalol (Betapace)
  • Timolol (Blocadren)
 
Reference: Association of β-Blocker Use With Heart Failure Hospitalizations and Cardiovascular Disease Mortality Among Patients With Heart Failure With a Preserved Ejection FractionA Secondary Analysis of the TOPCAT Trial
Daniel N. Silverman, MD1Timothy B. Plante, MD, MHS1Margaret Infeld, MD, MS1; et alPeter W. Callas, PhD1Stephen P. Juraschek, MD, PhD2Geoff B. Dougherty, PhD, MPH3Markus Meyer, MD1
JAMA Netw Open. 2019;2(12):e1916598. doi:10.1001/jamanetworkopen.2019.16598
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2756254