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The discharge of emerging pollutants, such as beta-blockers (BB), has been recognized as one of the major threats to the environment due to the ecotoxicity associated with these emerging pollutants. The BB are prescribed to treat high blood pressure and cardiovascular diseases; however, even at lower concentration, these pollutants can pose eco-toxic impacts towards aquatic organisms. Additionally, owing to their recalcitrant nature, BB are not effectively removed through conventional technologies, such as activated sludge process, trickling filter and moving bed bioreactor; thus, it is essential to understand the degradation mechanism of BB in established as well as embryonic technologies, like adsorption, electro-oxidation, Fenton process, ultraviolet-based advance oxidation process, ozonation, membrane systems, wetlands and algal treatment. In this regard, this review articulates the recalcitrant nature of BB and their associated removal technologies. Moreover, the major advantages and limitations of these BB removal technologies along with the recent advancements with regard to the application of innovative materials and strategies have also been elucidated. Therefore, the present review intends to aid the researchers in improving the BB removal efficiency of these technologies, thus alleviating the problem of the release of BB into the environment. [ABSTRACT FROM AUTHOR]

Aims: In the EXPLORER‐HCM trial, mavacamten improved exercise capacity and symptoms in patients with obstructive hypertrophic cardiomyopathy (oHCM). Mavacamten effects on the primary endpoint, a composite of peak oxygen consumption (VO2) and New York Heart Association (NYHA) class, were greater in patients not receiving background beta‐blockers than in those receiving beta‐blockers. We sought to determine if the effect of background treatment was consistent across other clinically meaningful parameters. Methods and results: Subgroup analyses by beta‐blocker use were performed in patients with oHCM from the EXPLORER‐HCM and mavacamten long‐term extension (MAVA‐LTE) studies. In EXPLORER‐HCM, 189 patients (75.3%) were receiving beta‐blockers, and 62 (24.7%) were receiving non‐dihydropyridine calcium channel blockers or no background HCM medication; 170 patients (90.4%) receiving beta‐blockers had chronotropic incompetence. Improvements in peak VO2 at week 30 with mavacamten versus placebo were lower with beta‐blockers (mean difference [95% confidence interval (CI)]: 1.04 [0.12, 1.95] ml/kg/min) than without beta‐blockers (mean difference [95% CI]: 2.69 [1.29, 4.09] ml/kg/min); improvements in non‐heart rate‐dependent parameters (VE/VCO2 slope) appeared unaffected by beta‐blockers. Improvements in functional capacity parameters at week 30 with mavacamten versus placebo were independent of beta‐blockade for post‐exercise left ventricular outflow tract gradient (mean difference [95% CI]: −37.9 [−48.0, −27.9] mmHg with beta‐blockers; −33.5 [−53.6, −13.3] mmHg without beta‐blockers), proportion of patients with reduction of ≥1 NYHA class, Kansas City Cardiomyopathy Questionnaire clinical summary scores and N‐terminal pro‐B‐type natriuretic peptide. Mavacamten benefits were reproduced and maintained in MAVA‐LTE regardless of beta‐blockade. Conclusion: Mavacamten improved measures of functional capacity, left ventricular outflow tract obstruction, symptom burden and biomarkers in patients with HCM regardless of beta‐blocker use. Beta‐blocker use was often associated with chronotropic incompetence, affecting peak VO2 and other heart rate‐dependent measures, but had minimal impact on heart rate‐independent measures. [ABSTRACT FROM AUTHOR]

Background: Contemporary patients with heart failure with reduced ejection fraction (HFrEF) are older and have a higher prevalence of cognitive impairment than those studied in trials. The risk/benefit trade‐off of routine beta‐blocker (BB) use in patients with HFrEF and Alzheimer's disease and related dementias (ADRD) has not been explored. This study aimed to determine the association between BB use and outcomes among patients with HFrEF and ADRD. Methods: Using a random 40% sample of Medicare Parts A, B, and D data we identified patients with ≥1 hospitalization for HFrEF between 2008 and 2018. Each patient was classified based on BB use prior to admission and after discharge. Outcomes include 90‐day and 1‐year mortality and readmission. Results: Between 2008 and 2018, we identified 357,030 patients hospitalized with HFrEF; 12.7% had ADRD. Patients with HFrEF and ADRD had higher 90‐day and 1‐year mortality compared to patients with HFrEF‐only. Among patients admitted on a BB, 60.5% of patients with HFrEF‐only were continued on therapy after discharge, compared to 56.8% of patients with HFrEF and ADRD. Discontinuing BB was associated with a 2.2‐fold higher risk of 90‐day mortality (p < 0.001) among patients with HF‐only and a 2.‐ fold higher risk of 90‐day mortality (p < 0.001) among patients with HFrEF + ADRD. Not starting a BB was associated with a 1.8‐fold higher risk of 90‐day mortality (p < 0.001) among patients with HFrEF‐only and a 1.7‐fold higher risk of 90‐day mortality (p < 0.001) among patients with HFrEF + ADRD. Similar risks were seen at 1 year. Conclusions: BB therapy is associated with significantly lower short and long‐term mortality rates among all patients with HFrEF; the magnitude of these associated benefits appear at least as large in patients with HFrEF and ADRD compared to patients with HFrEF‐only. [ABSTRACT FROM AUTHOR]

Background: The highly β1-selective beta-blocker Landiolol is known to facilitate efficient and safe rate control in non-compensatory tachycardia or dysrhythmia when administered continuously. However, efficacy and safety data of the also-available bolus formulation in critically ill patients are scarce. Methods: We conducted a retrospective cross-sectional study on a real-life cohort of critical care patients, who had been treated with push-dose Landiolol due to sudden-onset non-compensatory supraventricular tachycardia. Continuous hemodynamic data had been acquired via invasive blood pressure monitoring. Results: Thirty patients and 49 bolus applications were analyzed. Successful heart rate control was accomplished in 20 (41%) cases, rhythm control was achieved in 13 (27%) episodes, and 16 (33%) applications showed no effect. Overall, the heart rate was significantly lower (145 (130–150) vs. 105 (100–125) bpm, p < 0.001) in a 90 min post-application observational period in all subgroups. The median changes in blood pressure after the bolus application did not reach clinical significance. Compared with the ventilation settings before the bolus application, the respiratory settings including the required FiO2 after the bolus application did not differ significantly. No serious adverse events were seen. Conclusions: Push-dose Landiolol was safe and effective in critically ill ICU patients. No clinically relevant impact on blood pressure was noted. [ABSTRACT FROM AUTHOR]

The regularities of chromatographic retention and separation enantioselectivity of the selected β-blockers (propranolol, pindolol, alprenolol, atenolol, oxprenalol, metoprolol, clenbuterol, sotalol, pronethalol, salbutamol, and labetalol) were studied with eight chiral stationary phases (CSPs) in polar ionic mode (PIM) elution system. A range of novel CSPs was prepared by immobilisation of macrocyclic glycopeptide antibiotic eremomycin (E-CSP); structurally related antibiotics chloreremomycin (Chloro-E-CSP) and semi-synthetic oritavancin (O-CSP); and five eremomycin derivatives including amide- (Amide-E-CSP), adamantyl-2-amide- (Adamantylamide-E-CSP), eremomycin aglycon (EAg-CSP), eremosaminyl eremomycin aglycon (EEA-CSP), and des-eremosamynyl eremomycin (DEE-CSP) onto microspherical silica (Kromasil, particle size 5 micron, pore size 11 nm). The effect of different functional groups in eremomycin structure on chiral recognition of β-blockers was studied. The original E-CSP revealed moderate enantioseparation for all studied β-blockers. The presence of a free carboxylic group in a chiral selector molecule is found to be critical for the general retention of enantiomers as no separation enantioselectivity was recorded for Amide-E-CSP and Adamantyl-E-CSP. Modification of the aromatic system of eremomycin by the introduction of a chloro- substituent in the aromatic ring (Chloro-E-CSP) or a hydrophobic 4'-chlorobiphenylmethyl substituent to the disaccharide sugar residue (O-CSP) resulted in decreased enantioselectivity. The best enantioseparation of β-blockers was obtained for CSPs with eremosaminyl eremomycin aglycon and des-eremosamynyl eremomycin as chiral selectors. [ABSTRACT FROM AUTHOR]

Analysis of the genotype that predicts the phenotypic characteristics of a cohort of glaucoma and ocular hypertension patients, and the correlation with their personal pharmacological response to beta-blockers (BB) and prostaglandin analogues (PGA). Prospective study that included 139 eyes from 72 patients under BB and/or PGA treatment, and in some cases other types of ocular hypotensive treatments. Five single-nucleotide polymorphisms were genotyped by real-time PCR assays: prostaglandin-F2α receptor (rs3766355, rs3753380); cytochrome-P450 2D6 (rs16947, rs769258); and beta-2-adrenergic receptor (rs1042714). Other studied variables were mean deviation (MD) of visual field, previous ocular interventions, medical treatment, baseline (bIOP), and treated intraocular pressure (tIOP). From a total of 139 eyes, 71 (51.1%) were left eyes. The main diagnosis was primary open angle glaucoma (66.2%). A total of 57 (41%) eyes were under three or more medications (PGA + BB + other) and, additionally, 57 eyes (41%) had had some kind of glaucoma surgery. The mean bIOP and tIOP were 26.55 ± 8.19 and 21.01 ± 5.54 mmHg, respectively. Significant differences in tIOP were found between heterozygous (HT) (21.07 ± 0.607 mmHg) and homozygous (HM) (20.98 ± 0.639 mmHg) rs3766355 with respect to wildtype individuals (16 ± 1.08 mmHg) (p = 0.031). The MD values presented significant differences between wildtype rs3766355 (−2 ± 2.2 dB), HT (−3.87 ± 4 dB), and HM carriers (−9.37 ± 9.51 dB) (p = 0.009). Significant differences were also observed between the MD in wildtype rs3753380 (−6.1 ± 8.67 dB), HT (−9.02 ± 8.63 dB), and HM carriers (−9.51 ± 7.44 dB) (p = 0.017). Patients carrying the variant rs3766355 in HM or HT presented clinically-significantly higher tIOP than wildtype patients. Additionally, some differences in MD were found in rs3766355 and rs3753380 carriers, and the more alleles that were affected, the worse the MD value, meaning greater severity of the glaucoma. Poor response to treatment and more visual field damage may be associated with being a carrier of these mutated alleles. [ABSTRACT FROM AUTHOR]

Purpose of Review: The aim of this review was to determine the anticipated benefits and adverse effects of beta-blockers in pregnant women with hypertension. The other issue was to assess the possible adverse effects of beta-blockers for their babies and provide current consensus recommendations for appropriate selection and individualized antihypertensive treatment with beta-blockers in pregnancy-associated hypertension. Recent Findings: Hypertensive disorders of pregnancy are a major cause of maternal and fetal morbidity, with consequences later in life. Certain beta-blockers are useful for ameliorating hypertension in pregnancy and may have a protective role in endothelial dysfunction. However, some aspects of beta-blocker use in pregnancy are contentious among providers. Evidence on their safety, although well documented, is variable, and recent research reveals areas of controversy. Besides intrauterine growth restriction, other neonatal and obstetric complications remain a concern and should be explored thoroughly. Summary: Attention is necessary when treating pregnancy-associated hypertensive disorders with beta-blockers. Specific beta-blockers are considered safe in pregnancy, although the associated effects in the fetus are not clearly known and evidence is lacking for many safety outcomes, other than intrauterine growth restriction. Nevertheless, beta-blockers with specific indications in pregnancy under individualized selection and monitoring may confer substantial improvements in pregnant women with hypertension. [ABSTRACT FROM AUTHOR]

Background: Radionuclide ventriculography (RNVG) can be used to quantify mechanical dyssynchrony and may be a valuable adjunct in the assessment of heart failure with reduced ejection fraction (HFrEF). The study aims to investigate the effect of beta-blockers on mechanical dyssynchrony using novel RNVG phase parameters. Methods: A retrospective study was carried out in a group of 98 patients with HFrEF. LVEF and dyssynchrony were assessed pre and post beta-blockade. Dyssynchrony was assessed using synchrony, entropy, phase standard deviation, approximate entropy, and sample entropy from planar RNVG phase images. Subgroups split by ischemic etiology were also investigated. Results: An improvement in dyssynchrony and LVEF was measured six months post beta-blockade for both ischemic and non-ischemic groups. Conclusions: A significant improvement in dyssynchrony and LVEF was measured post beta-blockade using novel measures of dyssynchrony. [ABSTRACT FROM AUTHOR]

Simple Summary: Recent ESC Atrial Fibrillation guidelines introduced some changes in the options for rate control, such as the possibility to combine beta-blockers and non-dihydropyridine calcium channel blockers to address the need for a personalised pharmacologic rate control treatment for AF. However, there are limited data on this topic. This real-world prospective observational study aims to explore the prognostic impact of a patient-specific therapy for rate control in atrial fibrillation, including the use of non-dihydropyridine calcium channel blockers in patients with heart failure or in combination with beta-blockers, compared to standard rate control therapy, as defined by previous ESC guidelines. We performed an analysis of 1112 patients on exclusive rate control treatment referred to our University Hospital. Our results showed no difference in the one-year overall survival in the patient-specific therapy group compared to the standard treatment group. The use of non-dihydropyridine calcium channel blockers for rate control in patients with atrial fibrillation, either alone or in combination with beta-blockers, showed clinical benefit in selected patients, including a group of subjects with heart failure. Future controlled studies are needed to confirm our findings and identify subjects who will obtain greater benefit from such patient-specific rate-control strategies. Atrial fibrillation (AF) is a multifaceted disease requiring personalised treatment. The aim of our study was to explore the prognostic impact of a patient-specific therapy (PT) for rate control, including the use of non-dihydropyridine calcium channel blockers (NDDC) in patients with heart failure (HF) or in combination with beta-blockers (BB), compared to standard rate control therapy (ST), as defined by previous ESC guidelines. This is a single-centre prospective observational registry on AF patients who were followed by our University Hospital. We included 1112 patients on an exclusive rate control treatment. The PT group consisted of 125 (11.2%) patients, 93/125 (74.4%) of whom were prescribed BB + NDCC (±digoxin), while 85/125 (68.0%) were HF patients who were prescribed NDCC, which was diltiazem in all cases. The patients treated with a PT showed no difference in one-year overall survival compared to those with an ST. Notably, the patients with HF in ST had a worse prognosis (p < 0.001). To better define this finding, we performed three sensitivity analyses by matching each patient in the PT subgroups with three subjects from the ST cohort, showing an improved one-year survival of the HF patients treated with PT (p = 0.039). Our results suggest a potential outcome benefit of NDCC for rate control in AF patients, either alone or in combination with BB and in selected patients with HF. [ABSTRACT FROM AUTHOR]

Compelling evidence supports the hypothesis that stress negatively impacts cancer development and prognosis. Irrespective of its physical, biological or psychological source, stress triggers a physiological response that is mediated by the hypothalamic-pituitary-adrenal axis and the sympathetic adrenal medullary axis. The resulting release of glucocorticoids and catecholamines into the systemic circulation leads to neuroendocrine and metabolic adaptations that can affect immune homeostasis and immunosurveillance, thus impairing the detection and eradication of malignant cells. Moreover, catecholamines directly act on β-adrenoreceptors present on tumor cells, thereby stimulating survival, proliferation, and migration of nascent neoplasms. Numerous preclinical studies have shown that blocking adrenergic receptors slows tumor growth, suggesting potential clinical benefits of using β-blockers in cancer therapy. Much of these positive effects of β-blockade are mediated by improved immunosurveillance. The present trial watch summarizes current knowledge from preclinical and clinical studies investigating the anticancer effects of β-blockers either as standalone agents or in combination with conventional antineoplastic treatments or immunotherapy. [ABSTRACT FROM AUTHOR]

Background: The relationship between depression and beta-blockers (BBs) use is a controversial topic for many decades. Due to the interference with adrenergic and serotonin receptors, BB use has been linked to depression in many early cross-sectional and case studies. Others have investigated the indirect relationship between BB use and novice antidepressant use. However, larger trials have yielded inconsistent findings. The objective of this study is to identify the presence of depression and depressive symptoms among patients using BBs in the internal medicine, cardiology, and psychiatry Departments in King Khalid University Hospital (KKUH) and to measure its prevalence. Research Design and Methods: A cross-sectional study included patients visiting Internal Medicine, Cardiology, and Psychiatry clinics at the KKUH in Riyadh, Saudi Arabia, who is known using BBs for any indication and excluded patients previously diagnosed with depression before taking BBs. This study was carried out from December 2018 to October 2019. Either physically or over the phone, patients were requested to complete the Patient Health Questionnaire-9 questionnaire. Drug names and pictures were provided for ease of drug identification. The sample size was 291, with a confidence interval of 95% and 5% margin of error. Written consent was acquired from all participants. Results: Two hundred and ninety-one surveys were collected, among 151 (52%) were females and 140 (48%) were males. Females were more likely to report depressive symptoms and had higher scores of symptom severity on average (P < 0.016). Only 17 patients (5.8%) were found to report no depressive symptoms, while most patients reported mild depressive symptoms (35%). We have not found a statistically significant relationship between BB type and the magnitude of depressive symptoms severity. Conclusions: Although the usage of BBs and the prevalence of depressive symptoms were not directly correlated in our study, compared to the local prevalence, our patients demonstrated a higher prevalence trend of depressed symptoms. In addition, our observations did reveal fascinating information on the gender disparity in depression. [ABSTRACT FROM AUTHOR]

Introduction: Beta-blockers are proven to be safe and cost-effective agents in treating multiple dermatological conditions, which is why they are considered as an interesting and good alternative therapeutic agent by dermatologists. To our knowledge, there has been no comprehensive systematic review to date summarizing the role of both systemic and topical beta-blockers in dermatology. Methods: In this systematic review, we aim to review recent and relevant published literature in order to provide a comprehensive evidence-based summary to inform dermatologists. Results: An electronic-based literature search was carried out during October–December 2021 in the databases PubMed (MEDLINE), SCOPUS (EMBASE), and Cochrane Library. Furthermore, bibliographic sources were also reviewed for the selected articles. We followed The Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 (PRISMA) guidelines. We reviewed published literature about the role of beta-blockers in dermatology for the time period (January 2016 to December 2021). Conclusions: A total of 126 publications were retrieved from different databases, of which 59 studies were finally included in our review after excluding non-eligible literature in accordance with our inclusion and exclusion criteria. The included articles consisted of meta-analyses, systematic reviews, clinical trials, retrospective and prospective cohort studies, case–control studies, case series, and case reports. In general, data in reviewed literature showed that both systemic and topical beta-blockers were reliable and safe therapeutic options in treating different dermatoses. Their effect has been studied as a mono-therapy, also as an adjuvant therapy combined with other current disease-specific therapeutic modalities such as lasers, radiation, chemotherapy, corticosteroids, or other beta-blockers options. Local and systemic adverse effects were mainly minor and non-significant. [ABSTRACT FROM AUTHOR]

Background: Prolonged usage of topical antiglaucoma medications may result in ocular surface disease (OSD) that impairs both life quality and medication adaptation. Objective: The aim of the current study is to assess corneal epithelial thickness (CET) changes using anterior segment optical coherence tomography (AS-OCT) in patients using topical combination of beta-blockers and carbonic anhydrase inhibitors (CAIs). Patients and Methods: A total of 100 eyes of 80 participants were assessed in a randomized controlled clinical trial. Group A included 50 eyes of 40 glaucoma patients treated with combined topical Beta-blockers and CAIs with at least 3-month duration, while Group B included 50 eyes of 40 healthy participants with completely normal ophthalmological examination. All candidates received AS-OCT imaging with subsequent automated CET and total corneal thickness (CT) mapping. Results: Group A had a mean age of 49.84 (SD 4.83) years, while Group B had a mean age of 49.44 (SD 4.81) years (P=0.679). CET was considerably lower in all regions in Group A 45.94 (SD 3.96) µm compared to Group B 54.54 (SD 3.16) µm; (P-value<0.001). Regarding CT, 8 out of 25 regions were significantly lower in eyes of Group A compared to Group B. There were significant positive correlations between break up time test (BUT) and CET in Group A. Conclusion: Topical antiglaucomatous medications seem to affect CET in glaucoma patients as CET was thinner in glaucoma patients, in all regions, than controls, while these medications seem to focally affect CT in some regions. Further studies are required to assess the clinical implications of these findings. [ABSTRACT FROM AUTHOR]

Background and Objectives: Osteoporosis results in increasing morbidity and mortality in hemodialysis patients. The medication for treatment has been limited. There is evidence that beta-blockers could increase bone mineral density (BMD) and reduce the risk of fracture in non-dialysis patients, however, a study in hemodialysis patients has not been conducted. This study aims to determine the association between beta-blocker use and bone mineral density level in hemodialysis patients. Materials and Methods: We conducted a cross-sectional study in hemodialysis patients at Thammasat University Hospital from January 2018 to December 2020. A patient receiving a beta-blocker ≥ 20 weeks was defined as a beta-blocker user. The association between beta-blocker use and BMD levels was determined by univariate and multivariate linear regression analysis. Results: Of the 128 patients receiving hemodialysis, 71 were beta-blocker users and 57 were non-beta-blocker users (control group). The incidence of osteoporosis in hemodialysis patients was 50%. There was no significant difference in the median BMD between the control and the beta-blocker groups of the lumbar spine (0.93 vs. 0.91, p = 0.88), femoral neck (0.59 vs. 0.57, p = 0.21), total hip (0.73 vs. 0.70, p = 0.38), and 1/3 radius (0.68 vs. 0.64, p = 0.40). The univariate and multivariate linear regression analyses showed that the beta-blocker used was not associated with BMD. In the subgroup analysis, the beta-1 selective blocker used was associated with lower BMD of the femoral neck but not within the total spine, total hip, and 1/3 radius. The multivariate logistic regression showed that the factors of age ≥ 65 years (aOR 3.31 (1.25–8.80), p = 0.02), female sex (aOR 4.13 (1.68–10.14), p = 0.002), lower BMI (aOR 0.89 (0.81–0.98), p = 0.02), and ALP > 120 U/L (aOR 3.88 (1.33–11.32), p = 0.01) were independently associated with osteoporosis in hemodialysis patients. Conclusions: In hemodialysis patients, beta-blocker use was not associated with BMD levels, however a beta-1 selective blocker used was associated with lower BMD in the femoral neck. [ABSTRACT FROM AUTHOR]

Introduction: Midodrine, an α-adrenergic agonist approved for orthostatic hypotension, is used off-label for hypotension in patients with heart failure with reduced ejection fraction (HFrEF). However, its prevalence, clinical outcomes, and risks in HFrEF remain unclear. Theoretically, adding midodrine to HFrEF patients' medication regimens may facilitate up-titration of guideline-directed medical therapy (GDMT) by attenuating its corresponding hypotensive effects. This study aims to assess the concurrent use of midodrine and β-blockers in patients with HFrEF to allow the initiation or up-titration of GDMT. Methods: This was a multisite, retrospective chart review of adult patients with HFrEF who received concomitant treatment with midodrine and a β-blocker from March to June 2022. Patients were excluded if they were pregnant, had a left ventricular ejection fraction (LVEF) ≥ 50%, or received concomitant therapy for less than 48 hours. Primary outcomes included tolerance of β-blocker initiation and up-titration with midodrine. Secondary outcomes included initiation and continuation of midodrine and β-blockers or additional GDMT upon discharge. Results: Twenty-six patients were included. All patients on midodrine were initiated on β -blockers, and 73% (n = 19) tolerated β-blocker dose titration. An improvement in mean systolic blood pressure (SBP) from 104 mmHg to 112 mmHg was observed. Nineteen (73%) patients were discharged on midodrine and β-blockers, while 7 (27%) patients were discharged on β-blockers alone. Discussion: The initiation of midodrine improved mean SBP and enhanced tolerability of β-blockers in HFrEF patients. Further studies with larger sample sizes are necessary to evaluate midodrine's long-term risks and benefits in HFrEF. [ABSTRACT FROM AUTHOR]

Abstract Background Beta‐blockade is sometimes used in dogs with pulmonic stenosis with the intent of reducing frequency of ventricular arrhythmias during right heart catheterization. Objectives To evaluate if pretreatment with atenolol reduces frequency of ventricular arrhythmias, anesthetist interventions, or shortens procedure time. Animals Thirty dogs with pulmonic stenosis scheduled for interventional procedures. Methods Single center, prospective, randomized, open‐label study. Dogs were randomized to treatment with atenolol or no treatment preoperatively for a minimum of 10 days. Variables recorded included heart rate, arrhythmias and complexity, total procedure time and administration of antiarrhythmic treatment, vasopressors, positive chronotropes, or fluid boluses. Results Fifteen dogs were enrolled in each group. Dogs receiving atenolol had lower mean heart rates during the procedure (atenolol 100 ± 11 bpm vs untreated 115 ± 19 bpm, P = .01). There were no significant differences between the atenolol and untreated groups in the frequency of ventricular ectopic complexes (535 [6‐5296] vs 553 [79‐2863], P = .9), ventricular couplets (46 [0‐481] vs 29 [3‐121], P = .59), ventricular triplets (20 [0‐265] vs 16 [1‐82], P = .67), ventricular tachycardia (8 [0‐224] vs 8 [1‐118], P = .99), proportion exhibiting R‐on‐T phenomenon (11/15 vs 14/15, P = .33), proportion receiving intraoperative lidocaine (1/15 vs 3/15, P = .6), vasopressors/positive chronotropes (11/15 vs 5/15, P = .06), or fluid boluses (12/15 vs 7/15, P = .13). The procedure time was similar (atenolol 41 [23‐68] min vs untreated 35 [18‐98] min, P = .91). Conclusions and Clinical Importance No benefit of preoperative atenolol treatment was identified in this small group of dogs.

Background and Aim There are conflicting results about the early administration of beta-blockers (bb) on in-hospital mortality and arrhythmias. Here, we wanted to investigate the effects of chronic bb use on in-hospital Atrial Fibrillation (AF) development in ST-Elevation Myocardial Infarction (STEMI) patients. Materials and Methods A total of 814 consecutive patients with STEMI were included in the study. They were divided into two groups according to whether they are using bb on admission or not. They were followed for AF development in-hospital and predictors of AF were determined by multivariable logistic regression analysis. Results Of the 814 patients, 103 (12.67%) patients were already using bb, while 711 (87.3%) were not. There were no significant differences in the frequency of AF development [3 (%2.9) vs 30 (%4.2), p = .788] between the groups. Multivariable logistic regression analysis showed that left atrial (LA) diameter is the only independent predictor of in-hospital AF development. Conclusions Our study showed that chronic bb use does not have an effect on in-hospital AF development in STEMI patients. Nevertheless, LA diameter was found to be an independent predictor of AF.

Abstract Background The role of beta-blockers in acute myocardial infarction patients without heart failure and with preserved left ventricular ejection fraction (LVEF ≥ 50%) is unknown. Our study aimed to retrospectively analyze the associations of beta-blockers on such patients. Methods This is a multicenter, retrospective study. After screening 5,332 acute myocardial infarction patients, a total of 2519 patients without heart failure and with LVEF ≥ 50% were included. The patients were divided into two groups: the prescribed (n = 2049) and unprescribed (n = 470) beta-blockers group. The propensity score inverse probability treatment weighting was used to control confounding factors. We analyzed the associations between beta-blockers and outcomes in the short-term (1-year) and long-term (median, 3.61 years). Results The primary outcome was all-cause mortality. The secondary outcomes were all-cause rehospitalization, cardiac death, recurrent myocardial infarction, new-onset heart failure rehospitalization. This study shows no statistically significant association between discharged with beta-blockers and all-cause mortality, either in the short-term [IPTW Adjusted, HR 1.02; 95%CI 0.43–2.40; P = 0.966] or long-term [IPTW Adjusted, HR 1.17; 95%CI 0.70–1.94; P = 0.547]. Discharged with beta-blockers was significantly associated with a reduced risk of short-term recurrent myocardial infarction [IPTW Adjusted, HR 0.44; 95%CI 0.20–0.97; P = 0.043], but there was no long-term relationship [IPTW Adjusted, HR 1.11; 95%CI 0.61–2.03; P = 0.735]. Other outcomes, such as new-onset heart failure rehospitalization and all-cause rehospitalization, were not observed with meaningful differences in either the short- or long-term. The results of sensitivity analysis were consistent with this. Conclusions Beta-blockers might be associated with a reduced risk of recurrent myocardial infarction in patients without heart failure and with preserved left ventricular ejection fraction after acute myocardial infarction, in the short term. Beta-blockers might not be related to all-cause mortality in those patients, either in the short-term or long-term. Clinical trial registration Influence of Beta-blockers on Prognosis in Patients with Acute Myocardial Infarction Complicated with Normal Ejection Fraction, NCT04485988, Registered on 24/07/2020. Retrospectively registered.

Introduction: Beta-blockers (BBs) have proven their efficacy in reducing mortality in patients with heart failure with reduced ejection fraction (HFrEF). However, the effects in patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with mildly reduced ejection faction (HFmrEF) are less clear and consistent data are lacking.1,2The aim of this study was to examine the association of BB therapy with all-cause mortality in different groups of HF patients. Patients and Methods: We investigated BB use in real-life cohort of patients with heart failure (HF) diagnosis included in the registry in the period between June 2021 and February 2024. We compared all-cause mortality between patients who did not receive any BB therapy and patients receiving BB therapy at three different doses, defined as maximal, medium (≥50% of maximal dose) and low (≥25% of maximal dose). For statistical analysis we used chi-square and Fisher’s exact test and the p value of 0.05 was defined as statistically significant. Results: This registry-based study included 1009 patients with median age of 70 years (IQR 62-76), and median follow-up period of 365 days (IQR 184-367). Total of 247 patients had HFpEF (24.5%), 146 patients had HFmrEF (14.5%) and 616 patients had HFrEF (61.1%). In HFrEF group patients with BB therapy in any dose had significantly lower all-cause mortality compared to the patients without BB therapy (mortality rate 11 vs. 32%, p=.02). All-cause mortality rate between patients receiving BB therapy at any dose and patients without BB therapy in both HFmrEF and HFpEF group did not differ. There was no statistically significant difference in dose-related outcomes for three different BB doses in overall HF cohort, nor in each HF group separately. BB use in HFrEF patients with history of AF was associated with significantly lower all-cause mortality (7 vs. 47%, p<.00001), but these results did not translate to HFpEF nor HFmrEF patients with history of AF. Conclusion: Our findings indicate that BB do not improve survival in patients with HFmrEF and HFpEF, independently of history of AF. Real-life studies and well-designed registries with larger cohorts of patients and longer follow-up period are needed to investigate the impact of BB use and dosing on survival in different groups of HF patients. [ABSTRACT FROM AUTHOR]

Introduction: Beta-blockers are one of the four major pillars of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). The therapy has presented the best effects when up-titrated to evidence-based target doses. Despite their proven benefits, physicians have traditionally shown reluctance to up-titrate beta-blockers because of their negative inotropic and chronotropic effects. The effects of newly introduced sodium-glucose transporter 2 inhibitors (SGLT2I) in treating HFrEF might open more room for adequate beta-blockers up-titration1 . The goal of this study was to evaluate the up-titration practice, and impact of target doses of beta-blockers in patients with HFrEF receiving SGLT2I. Patients and Methods: This is a prospective cohort study involving patients with HFrEF receiving SGLT2I therapy. Up-titration to the evidence-based targets was examined. We compared the groups of patients receiving maximally titrated beta-blockers versus incompletely titrated. Primary outcome was composite of: 1) rehospitalization or revisit to emergency unit due to the heart failure; 2) all-cause death and major adverse cardiac events (MACE). Secondary outcomes were heart rate at rest, left ventricular ejection fraction, NT-proBNP and New York Heart Association (NYHA) status at 6 and 12 months of follow-up. Study endpoints were documented via telephone interviews, regular outpatient follow-up, or by electronic hospital records. Results: The study included 458 patients with median follow-up time of 365 (186-502) days. A total of 122 (26.6%) patients had maximally up-titrated beta-blockers. The results show adherence to maximal target doses of beta-blocker therapy significantly reduces hazard of death or MACE compared to not using maximal doses of beta-blocker (factor 0.43). Hazard reduction was not statistically significant for composite of rehospitalization or revisit to emergency unit due to HF. Maximal doses of beta-blockers did not result in a significant decrease in resting heart rate. Conclusion: Our real-world data have highlighted the prevalence of incomplete titration of beta-blockers. Although it has been shown that evidence-based target dosing of beta-blockers reduce death and MACE, there is still room for improvement with up-titrating beta-blockers in in eligible patients. [ABSTRACT FROM AUTHOR]

Background: Alzheimer’s disease (AD) is the most common cause of dementia, with a growing number of patients worldwide. The association between AD and treatment with drugs targeting the beta-adrenergic receptor is controversial. The aim of this study is to assess the association between the initiation of AD medication and beta-adrenoceptor antagonists (beta-blockers) in adults. Materials and Methods: We conducted a prescription sequence symmetry analysis using the University of Groningen IADB.nl prescription database. We determined the order of the first prescription for treating AD and the first prescription for beta-blockers, with the dispensing date of the first prescription for AD defined as the index date. Participants were adults over 45 years old starting any AD medication and beta-blockers within two years. We calculated adjusted sequence ratios with corresponding 95% confidence intervals. Results: We identified 510 users of both AD and beta-blockers, and 145 participants were eligible. The results were compatible with either a significant decrease in the incidence of AD after using beta-blockers (adjusted sequence ratio (aSR) = 0.52; 95% CI: 0.35–0.72) or, conversely, an increase in beta-blockers after AD medication (aSR = 1.96; 95% CI: 1.61–2.30). Conclusions: There is a relationship between the use of beta-blockers and AD medications. Further research is needed with larger populations to determine whether drug therapy for AD increases the risk of hypertension or whether beta-blockers have potential protective properties against AD development.

Background: Coronary CT angiography (CCTA) is increasingly used as a non-invasive tool to assess coronary artery disease (CAD). However, CCTA is subject to motion artifacts, potentially limiting its clinical utility. Despite faster (0.35 and 0.28 s/rot) gantry rotation times, low (60–65 bpm) heartbeat is recommended, and the use of β-blockers is often needed. Technological advancements have resulted in the development of faster rotation speeds (0.23 s/rot). However, their added value in patients not premedicated with β-blockers remains unclear. This prospective single-center, two-arm, randomized, controlled trial aims to assess the influence of fast rotation on coronary motion artifacts, diagnostic accuracy of CCTA for CAD, and patient safety. Methods: We will randomize a total of 142 patients aged ≥ 50 scheduled for an aortic stenosis work-up to receive CCTA with either a fast (0.23) or standard (0.28 s/rot) gantry speed. Primary outcome: rate of CCTAs with coronary motion artifacts hindering interpretation. Secondary outcomes: assessable coronary segments rate, diagnostic accuracy against invasive coronary angiography (ICA), motion artifact magnitude per segment, contrast-to-noise ratio (CNR), and patient ionizing radiation dose. The local ethics committee has approved the protocol. Potential significance: FAST-CCT may improve motion artifact reduction and diagnosis quality, thus eliminating the need for rate control and β-blocker administration. Clinicaltrials.gov identifier: NCT05709652.

Abstract Aims The effect of elevated heart rate (HR) on morbidity and mortality is evident in chronic stable heart failure; data in this regard in acute decompensated heart failure (ADHF) setting are scarce. In this single‐centre study, we sought to address the prognostic value of HR and beta‐blocker dosage at discharge on all‐cause mortality among patients with heart failure and reduced ejection fraction and ADHF. Methods and results In this retrospective observational study, 2945 patients were admitted for the first time with the primary diagnosis of ADHF between January 2008 and February 2018. Patients were divided by resting HR at discharge into three groups (HR 90 b.p.m.). Evidence‐based beta‐blockers were defined as metoprolol, bisoprolol, and carvedilol. The doses of prescribed beta‐blockers were calculated into a percentage target dose of each beta‐blocker and divided to four quartiles: 0 75% of the target dose. Cox regression was used to calculate the hazard ratio for various HR categories and adjusting for clinical and laboratory variables. At discharge, 1226 patients had an HR 90 b.p.m. The 30 day mortality rate was 2.2%, 3.7%, and 12.1% (P 90 b.p.m., respectively. The adjusted hazard ratio was significantly increased only in HR above 90 b.p.m. category (hazard ratio, 2.318; 95% confidence interval, 1.794–2.996). Conclusions Patients with ADHF and an HR of

Calcium channel blockers and beta-blockers toxicity/poisoning are one of the most common causes of poisoning. More importantly, they are among the deadliest types of poisoning caused by cardiac drugs that emergency physicians can encounter. Common toxidrome caused by these medications includes the following symptoms: hypotension, bradycardia, hypoglycemia/hyperglycemia, hypothermia, arrhythmia, and seizures. Treatment is usually complex, It consists of administration of various medications, such as crystalloids, intravenous calcium, glucagon, vasopressors/inotropes, and especially high-dose insulin euglycemic therapy. In this paper, we will review the mechanism for this type of treatment, propose a potential protocol for its application and address possible adverse effects. High-dose insulin euglycemic therapy should be an integral part of the treatment protocol for calcium channel blockers and beta-blockers toxicity.

Marfan syndrome (MFS), a multisystemic connective disorder, caused by fibrillin 1 gene mutations with autosomal dominant inheritance. The disease spectrum is wide and the major causes of death are related to aortic root aneurysm or dissection. The purposes of medical treatment are to reduce structural changes in the aortic wall and slow aortic root dilatation. Advance in medical researches have provided new insights into the pathogenesis of disease and opened up new horizons for treatments. Several medications such as angiotensin II type I receptor blockers, β-blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, tetracyclines, and statins have been studied for the purpose. Currently, the life expectancy of Marfan patients improves significantly and is closes to the general population with proper treatment. In this article, we review and update the medical treatments for patients with MFS.

The presence of some drugs in meat samples can cause threat to human health, therefore, its analysis is highly desirable for food safety purposes. In this work, a solid-phase extraction procedure for the determination of oxprenolol, a non-selective beta-blocker, and such anabolic agents as methandienone and testosterone in beef meat samples has been developed. Extraction conditions were optimized to achieve high sensitivity and accuracy of the results. The procedure was validated using meat samples free from target analytes. As a result, high selectivity and sensitivity were observed with the detection limits between 0.25 and 1.25 ng/g, and the results were not affected by matrix components. The proposed procedure was applied to the analysis of real beef samples purchased in the market, and the results have revealed the presence of contaminated samples. The concentration of oxprenolol in the contaminated sample was 7 ng/g, methandienone content in the sample was 30 ng/g, while testosterone level was 4 ng/g.

Beta-blockers have been considered as an effective treatment in secondary prevention of coronary heart disease (CHD). However, there is still disputed whether β-blockers can increase all-cause mortality in patients with coronary heart disease and diabetes mellitus (DM). Here, our systematic review and meta-analysis is aiming to assess the effects of β-blockers on all-cause mortality in patients with coronary heart disease and diabetes mellitus. Four databases (PubMed, Embase, Cochrane Library and Web of Science) and other sources were searched to collect randomized controlled trials (RCTs) and cohort studies related to the treatment of β-blockers for coronary heart disease and diabetes mellitus patients. We further evaluated quality of evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. Finally, a total of 16,188 records were identified, and four randomized controlled trials and six cohort studies (206,490 patients) were included. Random effects analysis revealed that β-blockers combined with routine treatment (RT) significantly decreased all-cause mortality in patients with coronary heart disease and diabetes mellitus compared with RT in control group (RR 0.59, 95% CI 0.47 to 0.75; p < 0.000 01; I2 = 72%). Subgroup analysis of all-cause mortality by the subtype of diabetes mellitus and definite MI patients (RR 0.54, 95% CI 0.45 to 0.65, p < 0.000 01, I2 = 29%) and the subtype of randomized controlled trials (RR 0.49, 95% CI 0.32 to 0.76, p = 0.001, I2 = 0%) indicated a relatively small heterogeneity and stable results. β-blockers application significantly reduced cardiovascular death as well (RR 0.56, 95% CI 0.42 to 0.74; p < 0.000 1; I2 = 0%). Our meta-analysis provided critical evidence of β-blockers treatment for patients with coronary heart disease (especially MI type) and diabetes mellitus, and discussed the advantages and potential metabolic risks for the clinical use of β-blockers. This study suggested that β-blockers application may improve all-cause mortality and cardiovascular death in coronary heart disease (especially MI type) and diabetes mellitus patients. However, given a small number of included studies, the aforementioned conclusion should be confirmed in a multi-center, large-scale, and strictly designed trial.

With increasing decompensation, hyperdynamic circulatory disturbance occurs in liver cirrhosis despite activation of vasoconstrictors. Here, the concept of a therapy with non-selective beta-blockers was established decades ago. They lower elevated portal pressure, protect against variceal hemorrhage, and may also have pleiotropic immunomodulatory effects. Recently, the beneficial effect of carvedilol, which blocks alpha and beta receptors, has been highlighted. Carvedilol leads to “biased-signaling” via recruitment of beta-arrestin. This effect and its consequences have not been sufficiently investigated in patients with liver cirrhosis. Also, a number of questions remain open regarding the expression of beta-receptors and its intracellular signaling and the respective consequences in the intra- and extrahepatic tissue compartments. Despite the undisputed role of non-selective beta-blockers in the treatment of liver cirrhosis, we still can improve the knowledge as to when and how beta-blockers should be used in which patients.

AimsTo assess whether nursing home (NH) residents with type 2 diabetes mellitus (T2D) preferentially received "T2D-friendly" (vs "T2D-unfriendly") β-blockers after acute myocardial infarction (AMI), and to evaluate the comparative effects of the two groups of β-blockers.Materials and methodsThis new-user retrospective cohort study of NH residents with AMI from May 2007 to March 2010 used national data from the Minimum Data Set and Medicare system. T2D-friendly β-blockers were those hypothesized to increase peripheral glucose uptake through vasodilation: carvedilol, nebivolol and labetalol. Primary outcomes were hospitalizations for hypoglycaemia and hyperglycaemia in the 90 days after AMI. Secondary outcomes were functional decline, death, all-cause re-hospitalization and fracture hospitalization. We compared outcomes using binomial and multinomial logistic regression models after propensity score matching.ResultsOf 2855 NH residents with T2D, 29% initiated a T2D-friendly β-blocker vs 24% of 6098 without T2D (P

AimTo investigate beta-blocker (BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.MethodsAdult 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 transplant.ResultsOf 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).ConclusionIn 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.

To assess the impact of secondary prevention medical therapies (statins, ACE-inhibitors/Angiotensin Receptor Blockers (ARB), beta-blockers (BB) and Dual Antiplatelet Therapy (DAPT)) on outcomes of patients with myocardial infarction with nonobstructive coronary artery disease (MINOCA). Five adjusted observational studies encompassing 10,546 were included in this meta-analysis. All-cause death was the primary endpoint, while Major Adverse Cardiovascular Events (MACE) and acute myocardial infarction (AMI) were the secondary endpoints. After 24 months of follow up, statins (tested in 8093 patients) were associated with a reduced risk of all-cause death (HR 0.60:0.45–0.81, p 〈0,001), while ACE-inhibitors/ARB (on 9666 patients) were not. Aggregate data from two studies (n = 9720, 7719 on beta-blockers, 6423 on DAPT) indicated that beta-blockers and DAPT (median follow-up 34.1 and 15.7 months, respectively) were both associated with a significant reduction of all-cause death (HR0.81:0.66–0.99, p = 0.04, and HR0.73:0.55–0.98, p = 0.03, for beta-blockers and DAPT, respectively). Among the investigated therapies, only ACE-inhibitors/ARBs entailed a reduced risk of MACE (HR0.65:0.44–0.94, p = 0.02, all CI 95%) over 36.5 months (four studies, n = 10,150). None of the investigated therapies was associated with a reduced risk of AMI. Data from adjusted observational studies suggest that beta-blockers, statins and DAPT are associated with a survival benefit among MINOCA patients. ACE-inhibitors/ARB entail a reduced risk of MACE while none of the investigated secondary prevention therapies is associated with a reduced risk of AMI. Randomized controlled trials are warranted to confirm these findings. • MINOCA are associated with a not negligible incidence of impaired prognosis and recurrent ischemic events. • There is a paucity of data investigating the impact of cardioprotective therapies on outcomes in this subset. • This meta-analysis suggests that beta-blockers, statins and DAPT are associated with a survival benefit for MINOCA patients • ACE-inhibitors/ARB provide a beneficial effect on reducing composite endpoints such as major adverse cardiovascular events. • None of the investigated therapies has a significant impact on lowering the risk of acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Angina is the main symptom of ischemic heart disease; mirroring a mismatch between oxygen supply and demand. Epicardial coronary stenoses are only responsible for nearly half of the patients presenting with angina; whereas in several cases; symptoms may underlie coronary vasomotor disorders; such as microvascular dysfunction or epicardial spasm. Various medications have been proven to improve the prognosis and quality of life; representing the treatment of choice in stable angina and leaving revascularization only in particular coronary anatomies or poorly controlled symptoms despite optimal medical therapy. Antianginal medications aim to reduce the oxygen supply-demand mismatch and are generally effective in improving symptoms; quality of life; effort tolerance and time to ischemia onset and may improve prognosis in selected populations. Since antianginal medications have different mechanisms of action and side effects; their use should be tailored according to patient history and potential drug-drug interactions. Angina with non-obstructed coronary arteries patients should be phenotyped with invasive assessment and treated accordingly. Patients with refractory angina represent a higher-risk population in which some therapeutic options are available to reduce symptoms and improve quality of life; but robust data from large randomized controlled trials are still lacking. [ABSTRACT FROM AUTHOR]

Beta-blockers have solid documentation in preventing cardiovascular complications in the treatment of hypertension; atenolol, metoprolol, oxprenolol and propranolol demonstrate proven cardiovascular prevention in hypertension mega-trials. Hypertension is characterised by activation of the sympathetic nervous system from early to late phases, which makes beta-blockers an appropriate treatment seen from a pathophysiological viewpoint, especially in patients with an elevated heart rate. Beta-blockers represent a heterogenous class of drugs with regard to both pharmacodynamic and pharmacokinetic properties. This position is manifest by reference to another clinical context, beta-blocker treatment of heart failure, where unequivocally there is no class effect (no similar benefit from all beta-blockers); there are good and less good beta-blockers for heart failure. Analogous differences in beta-blocker efficacy is also likely in hypertension. Beta-blockers are widely used for the treatment of diseases comorbid with hypertension, in approximately 50 different concomitant medical conditions that are frequent in patients with hypertension, leading to many de facto beta-blocker first choices in clinical practice. Thus, beta-blockers should be regarded as relevant first choices for hypertension in clinical practice, particularly if characterised by a long half-life, highly selective beta-1 blocking activity and no intrinsic agonist properties. Beta-blockers have solid documentation in preventing cardiovascular complications in the treatment of hypertension; atenolol, metoprolol, oxprenolol and propranolol demonstrate proven cardiovascular prevention in hypertension mega-trials Hypertension is characterised by activation of the sympathetic nervous system from early to late phases, which makes beta-blockers an appropriate treatment seen from a pathophysiological viewpoint, especially in patients with an elevated heart rate Beta-blockers represent a heterogenous class of drugs with regard to both pharmacodynamic and pharmacokinetic properties This position is manifest by reference to another clinical context, beta-blocker treatment of heart failure, where unequivocally there is no class effect (no similar benefit from all beta-blockers); there are good and less good beta-blockers for heart failure Analogous differences in beta-blocker efficacy is also likely in hypertension Beta-blockers are widely used for the treatment of diseases comorbid with hypertension, in approximately 50 different concomitant medical conditions that are frequent in patients with hypertension, leading to many de facto beta-blockers first choices in clinical practice These observations, in totality, inform our opinion that beta-blockers are relevant first choices for hypertension in clinical practice and this fact needs highlighting Further, these arguments suggest European hypertension guideline downgrading of beta-blockers is not justified [ABSTRACT FROM AUTHOR]

Critical illness may lead to activation of the sympathetic system. The sympathetic stimulation may be further increased by exogenous catecholamines, such as vasopressors and inotropes. Excessive adrenergic stress has been associated with organ dysfunction and higher mortality. β-Blockers may reduce the adrenergic burden, but they may also compromise perfusion to vital organs thus worsening organ dysfunction. To assess the effect of treatment with β-blockers in critically ill adults, we conducted a systematic review and meta-analysis of randomized controlled trials. We conducted a search from three major databases: Ovid Medline, the Cochrane Central Register for Controlled Trials and Scopus database. Two independent reviewers screened, selected, and assessed the included articles according to prespecified eligibility criteria. We assessed risk of bias of eligible articles according to the Cochrane guidelines. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Sixteen randomized controlled trials comprising 2410 critically ill patients were included in the final review. A meta-analysis of 11 trials including 2103 patients showed a significant reduction in mortality in patients treated with β-blockers compared to control (risk ratio 0.65, 95%CI 0.53–0.79; p <.0001). There was no significant difference in mean arterial pressure or vasopressor load. Quality of life, biventricular ejection fraction, blood lactate levels, cardiac biomarkers and mitochondrial function could not be included in meta-analysis due to heterogenous reporting of outcomes. In this systematic review we found that β-blocker treatment reduced mortality in critical illness. Use of β-blockers in critical illness thus appears safe after initial hemodynamic stabilization. High-quality RCT's are needed to answer the questions concerning optimal target group of patients, timing of β-blocker treatment, choice of β-blocker, and choice of physiological and hemodynamic parameters to target during β-blocker treatment in critical illness. A potential outcome benefit of β-blocker treatment in critical illness exists according to the current review and meta-analysis. Administration of β-blockers to resuscitated patients in the ICU seems safe in terms of hemodynamic stability and outcome, even during concomitant vasopressor administration. However, further studies, preferably large RCTs on β-blocker treatment in the critically ill are needed to answer the questions concerning timing and choice of β-blocker, patient selection, and optimal hemodynamic targets. [ABSTRACT FROM AUTHOR]

Treating infantile hemangiomas with oral propranolol may be initiated in accordance with various protocols some require hospitalization. However, different adverse events have been reported during treatment, thus it is of special importance to find a protocol which is both safe and feasible. We performed a retrospective cohort study of all cases of infantile hemangiomas treated with oral propranolol at our institute between January 2010 and February 2020. Pretreatment evaluation consisted of pediatric cardiologist evaluation including electrocardiography and echocardiography. The propranolol starting dosage was 0.5 mg/kg bid; 2 weeks later the dosage was escalated to 1 mg/kg bid. During the initiation and escalation visits, heart rate and blood pressure were measured before and every hour for a total of 3 h, and blood glucose level was measured within the first hour of treatment. A total of 131 children were treated during the study period. Scalp, facial and genital region infantile hemangiomas were more prevalent in regard to their relative body surface area. No symptomatic bradycardia, hypotension, hypoglycemia, or any other adverse events were documented; few patients had asymptomatic bradycardia and hypotension, which were more common in infants below 6‐months of age. Only one patient had asymptomatic hypoglycemia, not requiring any intervention. Initiation and escalation of propranolol treatment for infantile hemangiomas proved to be safe, and without symptomatic adverse effects. However, considering the young age of the patients and the possible asymptomatic adverse reactions, we recommend the following simple protocol as presented, for pretreatment evaluation and short monitoring during treatment initiation and dose escalation. [ABSTRACT FROM AUTHOR]

Introduction: The lives of college students are full of various stressors. Students seek a number of stress‐relieving modalities as self‐prescribed beta‐blockers to improve their academic performance. The aim of this study was to assess the extent of beta‐blockers (propranolol) usage amongst Saudi dental students and their attitude towards its use to enhance academic performance. Methods: A cross‐sectional study involving a convenient sample was conducted on a group of undergraduate dental students enrolled in Riyadh dental schools during the academic year of 2019/2020. A paper format closed‐ended questionnaire was used. Results: A sample of 680 students participated in the survey (43% response rate). Approximately 12% of dental students used propranolol for non‐medical reasons. The prevalence did not differ significantly with the gender or year of study. A significantly higher percentage of students from private dental schools reported using propranolol for non‐medical reasons (odds ratio (OR), 3.1; 95% confidence interval (CI), 1.7–5.4; p <.001). Propranolol users were significantly more likely to connect with other students using the medication. Both students, those who used and those who did not use propranolol, similarly, highly endorsed the need for being informed about the risk of using propranolol. Compared with non‐users, there was more disagreement amongst propranolol users on the necessity for placing school regulations controlling medication use. Conclusion: The use of propranolol to enhance academic performance amongst dental students in Saudi Arabia should not be disregarded. The study findings emphasise the importance of regulating students' usage of beta‐blockers to promote a fair academic environment. [ABSTRACT FROM AUTHOR]

Aim: Half of heart failure (HF) patients have chronic kidney disease (CKD) complicating their pharmacological management. We evaluated physicians' and patients' patterns of use of evidence‐based medical therapies in HF across CKD stages. Methods and results: We studied HF patients with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction enrolled in the Swedish Heart Failure Registry in 2009–2018. We investigated the likelihood of physicians to prescribe guideline‐recommended therapies to patients with CKD, and of patients to fill the prescriptions within 90 days of incident HF (initiating therapy), to adhere (proportion of days covered ≥80%) and persist (continued use) on these treatments during the first year of therapy. We identified 31 668 patients with HFrEF (median age 74 years, 46% CKD). The proportions receiving a prescription for angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor–neprilysin inhibitors (ACEi/ARB/ARNi) were 96%, 92%, 86%, and 68%, for estimated glomerular filtration rate (eGFR) ≥60, 45–59, 30–44, and <30 ml/min/1.73 m2, respectively; for beta‐blockers 94%, 93%, 92%, and 92%, for mineralocorticoid receptor antagonists (MRAs) 45%, 44%, 37%, 24%; and for triple therapy (combination of ACEi/ARB/ARNi + beta‐blockers + MRA) 38%, 35%, 28%, and 15%. Patients with CKD were less likely to initiate these medications, and less likely to adhere to and persist on ACEi/ARB/ARNi, MRA, and triple therapy. Among stoppers, CKD patients were less likely to restart these medications. Results were consistent after multivariable adjustment and in patients with HFmrEF (n = 15 114). Conclusions: Patients with HF and CKD are less likely to be prescribed and to fill prescriptions for evidence‐based therapies, showing lower adherence and persistence, even at eGFR categories where these therapies are recommended and have shown efficacy in clinical trials. [ABSTRACT FROM AUTHOR]

Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease affecting 1 in 5000 individuals. Epistaxis is seen in more than 90% of patients with HHT. Severe recurrent epistaxis can significantly decrease quality of life and may be resistant to standard treatment measures. Dysregulation of angiogenesis has been shown to cause the proliferation of abnormal blood vessels. As such, antiangiogenic treatments have been investigated including beta-blockers. Objective: A systematic review of the efficacy of beta-blockers in topical treatment of epistaxis in patients with HHT based on epistaxis duration, frequency, and severity. Methods: A systematic search was performed using the PubMed, Embase via Ovid, and Cochrane databases. The Preferred Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies that measured the efficacy of beta-blocker treatment of epistaxis in patients with HHT were included for qualitative analysis. Results: Five studies (3 randomized controlled trials and 2 case series) with a total of 132 patients were included. Administration (systemically or topically via a spray or gel) of timolol and propranolol showed mixed evidence of improvement in epistaxis frequency, severity, and duration when compared with control groups. The evidence for propranolol appears more promising than timolol. Conclusion: There are significant limitations in the included studies, and further investigation with larger longitudinal or randomized prospective trials is recommended. The available evidence suggests that beta-blocker treatment may have a positive effect on HHT-related epistaxis. [ABSTRACT FROM AUTHOR]

Background: Palpitations due to Graves' disease are often caused by supraventricular arrhythmia. However, in rare cases, the background of coronary artery disease, genetic abnormalities, or channel abnormalities can cause ventricular fibrillation, which is a lethal arrhythmia. Here, we report a case of ventricular fibrillation after administration of beta-blockers early in the course of treatment for Graves' disease coexisting with atypical angina and long QT syndrome. Case presentation: A 48-year-old man consulted a local general physician for chest discomfort and palpitations for approximately 2 weeks. He was diagnosed with Graves' disease and treated with thiamazole 15 mg, bisoprolol 1.25 mg, and nitroglycerin 0.3 mg. The patient continued to experience chest discomfort the next day and visited our hospital. The patient was treated with landiolol 0.125 mg/kg/min for heart rate control, and 20 min later, electrocardiography showed a change from the R-on-T phenomenon to ventricular fibrillation. After cardiopulmonary resumption and improvement of thyroid function, a stress test was performed, which revealed coronary angina and long QT syndrome. An implantable cardioverter defibrillator (ICD) was implanted in the patient for secondary prevention. Since then, no fatal arrhythmia has been observed to date. Conclusions: When beta-blockers are administered to patients with Graves' disease who have severe chest symptoms, fatal arrhythmias are possible. ICD implantation should be considered for the secondary prevention of fatal arrhythmias. [ABSTRACT FROM AUTHOR]

Background: Allergic contact dermatitis caused by topical ophthalmic medications (OftACD) is frequently difficult to confirm with patch testing and, therefore, it is considered uncommon. Methods: We collected retrospective data from a cohort of 65 patients with suspected OftACD patch tested in our Dermatology Unit (2005–2021) according to ESCD guidelines, using a series of topical drugs and excipients (Chemotechnique Diagnostics), including betaxolol and timolol 5% pet. kindly supplied by the pharmaceutical industry. Also, frequently used ophthalmic medications as well as patient's own products were also patch tested 'as is' in most patients. Results: Positive patch tests to ophthalmic medications occurred in 44 patients (67.7%) (38F/6M; mean age 63.1 years), with 102 positive reactions. Most positive reactions were associated with active ingredients (n = 56), especially aminoglycoside antibiotics (n = 27), followed by excipients (n = 24) such as sodium metabisulfite (n = 7). There were also positive reactions to topical products tested 'as is' (n = 22), mostly containing beta‐blockers, but only five of these reacted to the active ingredient. Discussion: This study reinforces previous findings in OftACD, such as older age of onset, and the importance of antibiotics, contrasting with the progressively lower prevalence of excipients. In addition, it helps raising awareness for the sensitization to beta‐blockers, which is probably underestimated. Patch test preparations for the diagnosis of OftACD may require protocol optimization. [ABSTRACT FROM AUTHOR]

Adherence to therapy is the key to a successful therapeutic intervention, especially in cardiovascular diseases in which a lack of adherence may have serious consequences in terms morbidity and/or mortality. In this context, hair analysis can be an excellent tool to monitor adherence to therapy. Indeed, drugs present in blood are incorporated into the hair matrix, where drugs and metabolites can stay unaltered for a long time protected from metabolism and degradation. In the present study, a simple, specific, and sensitive ultra‐high performance liquid‐chromatography–tandem mass spectrometry (UHPLC‐MS/MS) method set up to determine in human hair seven beta‐blockers (viz., metoprolol, sotalol, labetalol, atenolol, nebivolol, bisoprolol, and nadolol) and two calcium‐channel blockers (lercanidipine and amlodipine), which are widely prescribed to treat medium‐to‐severe hypertensive conditions. The optimized method was successfully validated in terms of accuracy, repeatability, reproducibility, matrix effect and extraction recovery. Moreover, the applicability of the method was evaluated by analyzing 34 real samples of hair obtained from patients under long‐term therapy with calcium channel blockers and beta‐blockers. [ABSTRACT FROM AUTHOR]

Introduction: The main treatment options for essential tremor (ET), which is probably one of the most common movement disorders, have been propranolol and primidone, for many years. This review aims to synthesize therapeutic attempts with other drugs., Areas Covered: We have reviewed the current state of the pharmacological treatment of ET, both in patients and in experimental models of this disease, with special emphasis on the data published in the last 5 years. Based on the results in experimental models of ET, proposals have been made for future alternative therapeutic options., Expert Opinion: The use of drugs other than propranolol and primidone has not shown a greater degree of efficacy than these in the treatment of ET, although according to certain evidence-based guidelines topiramate and phenobarbital could be alternative drugs. The results on the effectiveness of other drugs have been variable. For patients with refractory ET, especially those with head tremor, local injections with botulinum toxin A may be useful. According to the results of various experimental models, T calcium channel blockers, modulators of GABAA receptors (GABAARs), GABAB receptors (GABABRs), and glutamatergic neurotransmission, and drugs that decrease the expression of LINGO-1 could be interesting options for the future, among others.

Aims: Both patients with heart failure (HF) with reduced ejection fraction (HFrEF) and those with HF with preserved ejection fraction (HFpEF) present with elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) and have multiple comorbidities; consequently, the prognostic effect of NT-proBNP according to beta-blocker (BB) use is unknown., Methods: This retrospective study evaluated patients admitted for acute HF between January 2012 and December 2017 at Ulsan University Hospital. Clinical, echocardiographic, laboratory and drug prescription data, including BB data, were collected from the hospital database. Information on mortality was collected by reviewing medical records or using national death data., Results: Of the 472 patients evaluated, 216 (45.8%) and 256 (54.2%) patients were and were not prescribed BB at discharge, respectively. A total of 224 (47.5%) patients died within a median follow-up duration of 44 months. The Kaplan-Meier analysis showed reduced all-cause mortality with BB in HFrEF (ejection fraction ≤ 40%) but not in HFpEF (ejection fraction > 40%). In the multivariate Cox regression analysis, transmitral to tissue Doppler imaging, early diastolic velocity ratio (E/E'), NT-proBNP and BB use were independent predictors of all-cause mortality in HFrEF. Meanwhile, haemoglobin and NT-proBNP levels were independent predictors of HFpEF. The NT-proBNP cut-off value for determining all-cause mortality was set to 4800 pg/mL. Among HFrEF patients with NT-proBNP < 4800 pg/mL, the survival rate was higher for patients with BB use than those with no BB use (log-rank P < 0.001). However, in the HFpEF group, the survival rate associated with BB use did not differ according to the NT-proBNP levels. Both HFrEF and HFpEF patients with NT-proBNP levels of ≥4800 pg/mL presented with multiple comorbidities, including lower body mass index and haemoglobin levels and higher creatinine levels, NT-proBNP levels and E/E'., Conclusion: In patients with acute HF, BB use is associated with reduced all-cause mortality in those with HFrEF but not in those with HFpEF. HFrEF patients with NT-proBNP levels of <4800 pg/mL treated with BB have a higher survival rate than those not treated with BB. However, this benefit is not seen in HFrEF patients with NT-proBNP levels of ≥4800 pg/mL or in all HFpEF patients, regardless of the NT-proBNP level. NT-proBNP levels are elevated in multiple comorbid conditions, and these comorbidities may contribute to the attenuated effects of BB on all-cause mortality., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

β-blockers that easily cross the blood-brain barrier (BBB) seem to diminish the risk of Alzheimer's disease (AD), hypothetically facilitating waste clearance. However, their effect on AD pathophysiological markers is unknown. We compared cerebrospinal fluid (CSF) AD biomarker levels among non-demented individuals taking low, intermediate, or high BBB permeable β-blockers in two samples (ADNI: n  = 216; EPAD: n  = 79). We found that CSF amyloid-β levels were higher in individuals taking highly permeable β-blockers in the ADNI sample. This result was not replicated in EPAD, in which diminished levels of pTau181 and tTau were observed. These data suggest that β-blockers may impact AD pathophysiology., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article Gonzalo Sánchez-Benavides worked as a consultant for Roche Farma, S.A. Marc Suárez-Calvet has served as a consultant and at advisory boards for Roche Diagnostics International Ltd and has given lectures in symposia sponsored by Roche Diagnostics, S.L.U, Roche Farma, S.A and Roche Sistemas de Diagnosticos, Sociedade Unipessoal, Lda.Gonzalo Sánchez-Benavides is Editorial Board Member of this journal but was not involved in the peer-review process nor had access to any information regarding its peer-review. All other authors have no conflict of interest to report.

Background: Data on the clinical impact of beta-blockers (BBs) in patients with myocardial infarction (MI) who had non-reduced left ventricular ejection fraction (LVEF) after percutaneous coronary intervention are limited., Methods: From 2016 to 2020, we evaluated a cohort of 12,101 myocardial infarction patients with a non-reduced LVEF (≥40%) from the Korean Acute Myocardial Infarction Registry V. Patients were divided into two groups based on their BB (carvedilol, bisoprolol, or nebivolol) treatment at discharge: with beta-blocker treatment (BB, n  = 9,468) and without beta-blocker treatment (non-BB, n  = 2,633). The primary endpoint after discharge was the occurrence of patient-oriented composite endpoints (POCEs), including all-cause mortality, any MI, or any revascularization at 1-year follow-up., Results: The median follow-up period was 353 days (interquartile range, 198-378 days). At 1-year follow-up, no significant differences were observed in the primary endpoint between the BB group and the non-BB group. Before propensity score (PS) matching, the POCE incidence was 3.1% in the BB group vs. 3.4% in the non-BB group [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.68-1.09, p  = 0.225]. After PS matching, the POCE incidence remained similar between the two groups (3.7% vs. 3.4%, HR 1.01, 95% CI 0.76-1.35, p  = 0.931). Individual outcomes, including all-cause mortality, myocardial infarction, and revascularization, also showed no significant differences between the two groups. Independent predictors of 1-year POCEs after discharge were age, chronic kidney disease, reduced LVEF, and multivessel disease., Conclusion: BB treatment in patients with acute MI and non-reduced LVEF was not associated with a significant reduction in cardiovascular outcomes at 1-year follow-up., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Jeong, Park, Kim, Kim, Choi, Nam, Lee, Son, Park, Her, Chang, Ahn, Jeong, Rha, Kim, Gwon, Seong, Hwang, Hur, Cha, Oh, Chae and Kim.)