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beta-blockers and 1-year clinical outcomes in hospitalized heart failure patients with atrial fibrillation

Journal of Geriatric Cardiology 2021年第9期18卷 728-738页

作者： Fu-Wei XING Li-Hua ZHANG Hai-Bo ZHANG Xue-Ke BAI Dan-Li HU Xin ZHENG Jing LI National Clinical Research Center for Cardiovascular Diseases NHC Key Laboratory of Clinical Research for Cardiovascular MedicationsState Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeNational Center for Cardiovascular DiseasesBeijingChina

OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)*** We enrolled hospitalized HF patients with AF from China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure *** proportional hazard regression models were employed to calculate hazard ratio of *** primary outcome was all-cause *** Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire *** were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite *** the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(beta-blockers at discharge was not associated with 1-year clinical outcomes,regardless of LVEF.

关键词： beta-blockers and 1-year clinical outcomes in hospitalized heart failure patients with atrial fibrillation

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beta-blockers and physical frailty in patients with endstage liver disease

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World Journal of Gastroenterology 2018年第33期24卷 3770-3775页

作者： Selena Z Kuo Blanca Lizaola Hilary Hayssen Jennifer C Lai Division of Gastroenterology/Hepatology Department of Medicine University of CaliforniaSan Francisco

AIM To investigate beta-blocker(BB) use in patients with cirrhosis and determine their effects on physical frailty and overall *** Adult outpatients with cirrhosis listed for liver transplantation underwent testing of physical frailty using the performance-based Liver Frailty Index, comprised of chair stands, grip strength, and balance testing, as well as self-reported assessments of exhaustion and physical activity. BB use was assessed from medical chart review. Univariable and multivariable logistic regression were performed to determine BB use and their association with measures of physical frailty. Competing risk analyses were performed to determine the effect of BB use on wait-list mortality, as defined by death or delisting for being too sick for *** Of 344 patients, 35% were female, median age was 60, median model for end stage liver disease was 15, and 53% were prescribed a BB. Compared to those not on BB, patients on BB were similar except for percentage female(25% vs 46%; P < 0.001) and BMI(29 vs 28; P = 0.008). With respect to tests of physical frailty, BB use was not associated with increased odds of frailty(by the Liver Frailty Index), exhaustion, or low physical activity. BB use was, however, significantly associated with a decreased adjusted risk of mortality(SHR 0.55; P = 0.005).CONCLUSION In patients with cirrhosis awaiting liver transplantation, BB use is not associated with physical frailty. We confirmed the known survival benefits with BB use, and concerns about adverse effects should not deter their utilization when indicated.

关键词： beta-blockers Cirrhosis End-stage liver disease Frailty

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Twenty-four-hour ambulatory blood pressure changes in older patients with essential hypertension receiving monotherapy or dual combination antihypertensive drug therapy

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Journal of Geriatric Cardiology 2019年第4期16卷 354-361页

作者： Pei-Pei LU Xu MENG Ying ZHANG Yan-Qi LI Shu WANG Li-Sheng LIU Wen WANG Yu-Ling LI Yu-Qing ZHANG Ai-Hua HU Xian-Liang ZHOU Li-Hong MA Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Science and Peking Union Medical CollegeBeijingChina Clinical Trial and Research Center Beijing Hypertension League InstituteChinese Hypertension LeagueBeijingChina Xinjiekou Community Health Service Center BeijingChina Department of Traditional Chinese Medicine Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

Objective To evaluate the differences in 24-hour ambulatory blood pressure (BP) in older patients with hypertension treated with the five major classes of antihypertensive drugs,as monotherapy or dual combination therapy,to improve daytime and nighttime BP control. Methods We enrolled 1920 Chinese community-dwelling outpatients aged ≥ 60 years and compared ambulatory BP values and ambulatory BP control (24-hour BP blockers (CCBs) constituted the most common (60.3% of patients) monotherapy,and renin–angiotensin system (RAS) blockers combined with CCBs was the most common (56.5% of patients) dual combination therapy. Monotherapy with beta-blockers (BB) provided the best daytime BP control. The probabilities of having a nighttime dip pattern and nighttime BP control were higher in patients receiving diuretics compared with CCBs (OR = 0.52,P = 0.05 and OR = 0.41,P = 0.007,respectively). Patients receiving RAS/diuretic combination therapy had a higher probability of having controlled nighttime BP compared with those receiving RAS/CCB (OR = 0.45,P = 0.004). Compared with RAS/diuretic therapy,BB/CCB therapy had a higher probability of achieving daytime BP control (OR = 1.27,P = 0.45). Conclusions Antihypertensive monotherapy and dual combination drug therapy provided different ambulatory BP control and nighttime BP dip patterns. BB-based regimens provided lower daytime BP,whereas diuretic-based therapies provided lower nighttime BP,compared with other antihypertensive regimens.

关键词： Aging Ambulatory blood pressure monitoring Antihypertensive drugs beta-blockers Diuretics

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Mass spectrometry detection of basic drugs in fast chiral analyses with vancomycin stationary phases

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Journal of Pharmaceutical Analysis 2018年第5期8卷 324-332页

作者： Hongyue Guo M.Farooq Wahab Alain Berthod Daniel W.Armstrong Department of Chemistry and Biochemistry University of Texas at Arlington Institut des Sciences Analytiques CNRS Université de Lyon 1

Current trends in chiral analysis of pharmaceutical drugs are focused on faster separations and higher separation efficiencies, Core-shell or superficially porous particles （SPP） based chiral stationary phases （CSPs） provide reduced analysis times while maintaining high column efficiencies and sensitivity. In this study, mobile phase conditions suitable for chiral analyses with electrospray ionization LC-MS were systematically investigated using vancomycin as a representative CSP. The performance of a 2.7 μm SPP based vancomycin CSP （SPP-V） 10 cm ×0.21 cm column was compared to that of a corresponding 5 μm fully porous particles based analogue column. The results demonstrated that the SPP-V column provides higher efficiencies, 2-5 time greater sensitivity and shorter analysis time for a set of 22 basic pharma- ceutical drugs. The SPP-V was successfully applied for the analysis of the degradation products of racemic citalopram whose enantiomers could be selectively identified by MS.

关键词： Mass spectrometry detection Chiral separation Basic drugs beta-blockers Superficially porous particle Fully porous particle Fast separation Vancomycin

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Management of hypertensive crises in the elderly

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Journal of Geriatric Cardiology 2018年第7期15卷 514-522页

作者： Abbas Alshami Carlos Romero America Avila Joseph Varon Dorrington Medical Associates Houston Texas USA University of Baghdad/College of Medicine Baghdad Iraq Universidad Autonoma de San Luis Potosi San Luis Potosi Mexico Universidad Durango Santander Hermosillo Sonora Mexico The University of Texas Health Science Center at Houston USA The University of Texas Medical Branch at Galveston USA Critical Care Services United Memorial Medical Center / United General Hospital Houston Texas USA

Hypertensive crises are elevations of blood pressure higher than 180/120 mmHg. These can be urgent or emergent, depending on the presence of end organ damage. The clinical presentation of hypertensive crises is quite variable in elderly patients, and clinicians must be suspicious of non-specific symptoms. Managing hypertensive crises in elderly patients needs meticulous knowledge of the pathophysiological changes in them, pharmacological options, pharmacokinetics of the medications used, their side effects, and their interactions with other medications. Clevidipine, nicardipine, labetalol, esmolol, and fenoldopam are among the preferred choices in the elderly due to their efficacy and tolerability. Nitroprusside, hydralazine, and nifedipine should be avoided, unless there are no other options available, due to the high risk of complications and unpredictable responses.

关键词： beta-blockers Calcium channel blockers Clevidipine Elderly Esmolol Fenoldopam Hypertensive crises Labetalol Nicardipine Nitroprusside

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Medical management of symptomatic severe aortic stenosis in patients non-eligible for transcatheter aortic valve implantation

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Journal of Geriatric Cardiology 2020年第11期17卷 704-709页

作者： Gabriela Silvia Gheorghe Andreea Simona Hodorogea Andrei Cristian Dan Gheorghe Ioan Tiberiu Nanea Ana Ciobanu University of Medicine and Pharmacy Carol Davila BucharestProf.Dr.Th.Burghele HospitalBucharestRomania

1 Transcatheter aortic valve implantation in symptomatic severe aortic stenosis: where do we stand? Aortic stenosis occurs in 2%-9% of patients over the age of 65, the most common cause being degenerative.^([1,2]) The preferred treatment in symptomatic severe aortic stenosis(SAS) is surgical aortic valve replacement(SAVR), but in the elderly, the surgical risk can be greater than the benefit.([3]).

关键词： Angiotensin-converting enzyme inhibitors beta-blockers Calcium channel blockers Diuretics Symptomatic severe aortic stenosis Transcatheter aortic valve implantation

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Current and future pharmacological therapies for managing cirrhosis and its complications

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World Journal of Gastroenterology 2019年第8期25卷 888-908页

作者： David Kockerling Rooshi Nathwani Roberta Forlano Pinelopi Manousou Benjamin H Mullish Ameet Dhar Liver Unit/Division of Integrative Systems Medicine and Digestive Disease Imperial College London

Due to the restrictions of liver transplantation,complication-guided pharmacological therapy has become the mainstay of long-term management of *** article aims to provide a complete overview of pharmacotherapy options that may be commenced in the outpatient setting which are available for managing cirrhosis and its complications,together with discussion of current controversies and potential future ***/Medline/Cochrane Library were electronically searched up to December 2018 to identify studies evaluating safety,efficacy and therapeutic mechanisms of pharmacological agents in cirrhotic adults and animal models of ***-selective betablockers effectively reduce variceal re-bleeding risk in cirrhotic patients with moderate/large varices,but appear ineffective for primary prevention of variceal development and may compromise renal function and haemodynamic stability in advanced *** observational studies suggest protective,haemodynamically-independent effects of beta-blockers relating to reduced bacterial *** gut-selective antibiotic rifaximin is effective for secondary prophylaxis of hepatic encephalopathy;recent small trials also indicate its potential superiority to norfloxacin for secondary prevention of spontaneous bacterial *** remain the mainstay of uncomplicated ascites treatment,and early trials suggest alpha-adrenergic receptor agonists may improve diuretic response in refractory *** have not demonstrated clinical effectiveness in treating refractory ascites and may cause detrimental *** initial hepatotoxicity concerns,safety of statin administration has been demonstrated in compensated ***,statins are suggested to have protective effects upon fibrosis progression,decompensation and *** as to whether proton pump inhibitors cause gut-liver-brain axis dysfunction is *** evidence indicates that anticoa

关键词： Cirrhosis beta-blockers Rifaximin Diuretics Statins Proton pump inhibitors Pharmacology

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Evolution of care in cirrhosis: Preventing hepatic decompensation through pharmacotherapy

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World Journal of Gastroenterology 2023年第1期29卷 61-74页

作者： Seohyuk Lee Saad Saffo Department of Medicine Section of Digestive DiseasesYale School of MedicineNew HavenCT 06520-8019United States

Cirrhosis is a leading cause of morbidity and mortality,impacting more than 120 million people *** geographic differences exist,etiologic factors such as alcohol use disorder,chronic viral hepatitis infections,and non-alcoholic fatty liver disease are prevalent in nearly every ***,significant effort has been devoted to modifying these risks to prevent disease ***,more than 11%of patients with compensated cirrhosis experience hepatic decompensation each *** transition signifies the most important prognostic factor in the natural history of the disease,corresponding to a decline in median survival to below 2 *** the past decade,the need for pharmacotherapies aimed at reducing the risk for hepatic decompensation has been emphasized,and non-selective beta-blockers have emerged as the most effective option to ***,a critical therapeutic gap still exists,and additional therapies have been proposed,including statins,rifaximin,and sodium-glucose cotransporter-2 *** on the results of innovative retrospective analyses and small-scale prospective trials,these pharmacotherapies represent promising options,but further studies,including randomized controlled trials,are necessary before they can be incorporated into clinical *** report highlights the potential impact of these agents and others in preventing hepatic decompensation and discusses how this paradigm shift may pave the way for guideline-directed medical therapy in cirrhosis.

关键词： Cirrhosis Hepatic decompensation beta-blockers Statins Sodium-glucose cotransporter-2 inhibitors Rifaximin

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Diuretic window hypothesis in cirrhosis: Changing the point of view

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World Journal of Gastroenterology 2019年第26期25卷 3283-3290页

作者： Anderson Brito-Azevedo Liver Transplant Unit S?o Lucas Hospital Liver Transplant Unit S?o Francisco na Providência de Deus Hospital Liver Transplant Unit Adventist Silvestre Hospital

Since the 1970s,non-selective beta-blockers(NSBB)have been used to prevent variceal upper bleeding in advanced cirrhotic ***,several recent studies have raised the doubt about the benefit of NSBB in end-stage cirrhotic *** fact,they suggested a detrimental effect in these patients that even reduced *** of these studies have been assembled to compose the“window therapy hypothesis”,in which NSBB would have traditional indication to be initiated to prevent variceal upper bleeding;however,treatment should be stopped(or not be initiated)in patients with end-stage *** would reduce the cardiac reserve of these patients,worsening systemic perfusion and ***,it should be emphasized that these studies present important bias issues,and their results also suggested that diuretic treatment may also be behind the effects *** this opinion review,we changed the point of view from NSBB to diuretic treatment,based on a physiopathogenic approach of circulatory parameters of cirrhotic patients studied,and based on diuretic effect in blood pressure lowering and in other hypervolemic disease,as heart *** suggest a“diuretic window hypothesis”,composed by an open window in hypervolemic phase,an attention window when patient present in a normal plasma volume phase,and a closed window during the plasma hypovolemic phase.

关键词： Cirrhosis Non-selective beta-blockers Diuretic Window hypothesis Baveno Cardiac output

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Is heart rate reduction more important than target dose in chronic heart failure therapy with a beta-blocker?

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Journal of Geriatric Cardiology 2011年第4期8卷 260-262页

作者： Yong-Fang Guo Yi An Department of Cardiology The Affiliated Hospital of Medical College of Qingdao UniversityQingdao 266000Shandong ProvinceChina

1 Introduction beta-adrenoceptor blocking agents(beta-blockers)are now well established as cornerstone therapy in patients with systolic chronic heart failure(CHF).[1]Clinical data have overwhelmingly proven the beneficial effects of beta-blocker therapy in terms of improving patient prognosis,decreasing requirements for hospitalization,and postponing disease progression.[2-4]However,it remains unclear what the optimal efficacious and safe dose for an individual patient with CHF is,and whether this can simply be inferred from the target dose for each beta-blocking agent as used in the major clinical trials.

关键词： heart rate beta-blockers chronic heart failure

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