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Old 09-28-2010, 04:26 PM   #1
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Beta Blockers - Has Anyone Switched in Light of Recent Data?

Im curious if anyone has had their doctor suggest that they switch from beta blockers in the light the recent data showing limited mortality benefit in essential hypertension.

What is your thought on this? Should most folks wtih essential htn be actively seeking new meds based on this data?

Thanks.

Last edited by atengnr; 09-28-2010 at 04:26 PM.

 
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Old 10-01-2010, 03:01 PM   #2
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

Before switching, the alternatives to beta blockers, with the exception of certain Ace Inhibitors, are not at all beneficial. Beta blockers are the Cardiologist's best friend, becuase they are the most proven and effective. Calcium blockers are known to increase MI's, and ARB research, with the exception of Losartan, also increase the chance of Cardio-related problems. This is public information if you search it out. The only beta blocker which they are trying to disprove as being effective, is Atenolol the most popular blood pressure medication. TOPROL and COREG are probably the most effective and proven drugs researched. Diuretics are effective but they deplete many essentials minerals, which can effect other functions. The Ace Inhibitors, mainly Perindopril and Ramipril are the most proven to prevent strokes, MI's and Kidney issues. Aside from this small handfull of drugs , all others are unproven. Take at your own risk.

 
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Old 10-02-2010, 12:06 PM   #3
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

From Cochrane Review:

Beta-blockers for hypertension not as good as other classes of drugs

< edited >

The ACCOMPLISH trial showed benefit from aceis and ccbs.
http://cme.medscape.com/viewarticle/584722

I thought that the issue with MIs and CCBs was related to immediate release formulations, an issue from the 1990s??

Would you provide links to the studies you reference?

Thanks.

Last edited by hb-mod; 10-02-2010 at 01:45 PM. Reason: Please don't post unapproved websites, or copy and paste, per Posting Policy. Thanks!

 
Old 10-02-2010, 02:13 PM   #4
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

The board does not allow posting links. I can only say that Calcium blockers have also been related to increased Cancer Risk. They appear to be the worst of the bunch. There have been about 10 studies which have been published that associate the use of CCBs with an increased risk of mortality, MI, and cancer, these findings have caused widespread anxiety and frustration among patients and physicians. For health care professionals to properly advise patients, the facts surrounding this controversy are still being viewed. The ALLHAT study compared many drugs and combination of drugs, and found the cheapest diuretic to be the best of the bunch. I think the Beta blocker and Ace Inhibitor class of drugs is probably still the safest and can be used for many indications. If you must switch, at least it should be a drug which has been researched and provides much better long term results. Also,
another consideration is side effects, which one's can you better tolerate.

 
Old 10-02-2010, 03:01 PM   #5
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

How about the name(s) (or other descriptors) of the trials showing metoprolol superiority vs other antihypertensives?

In regards to CCB and cancer, I have searched this topic numerous times, and it appears that this result only showed up in ONE retrospective study published in the Lancet 1996. It has been refuted repeatedly in subsequent studies since 1996. Can you cite descriptors of other trials showing increased CA risk w/CCB?

Thanks.

Last edited by mod-anon; 10-02-2010 at 09:53 PM. Reason: Please use the Quick Reply button instead of Quote Reply.

 
Old 10-02-2010, 03:53 PM   #6
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

An article from the National Institute of Health has linked some calcium channel blockers to an increased risk of breast cancer in older women. This appeared in the October 15 issue of the journal Cancer. According to the study, postmenopausal women who took calcium channel blockers had twice the risk of developing breast cancer than other women. The overall cancer risk was not increased.

The Lancet article described how Calcium channel blockers can interfere with apoptosis, or regulated cell death, one of the body's defenses against cancer.

Metoprolol is the medication prescribed by many of the leading Cardiologists at NYU Medical Center and Colombia Presbyterian. They must feel very confident about the positive benefits.

 
Old 10-02-2010, 04:32 PM   #7
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

Thanks for the CCB info.

The Lancet article I am referring to was retrospective in regards to patients with CCB vs. antihypertensives not on CCBs. I recall conjecture about a hypothesis, but this is unrelated to the aim of the study.

So, you are not aware of data showing the strengths of beta blockers in uncomplicated hypertension? If you know of something please pass it along.

Last edited by mod-anon; 10-02-2010 at 09:53 PM. Reason: Please use the Quick Reply button instead of Quote Reply.

 
Old 10-02-2010, 05:49 PM   #8
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

The article from "Evidence Based Medicine- 2007, Aug 12" once again deals mainly with Atenolol as the comparatoe beta blocker drug. Other beta blockers such as Metoprolol, Bisoprolol and Betaxolol are somewhat different. The article concludes by saying, CHD was not significantly different between beta-blockers and diuretics or CCBs or RAS inhibitors.
The available evidence does not support the use of beta-blockers as first-line drugs in the treatment of hypertension. This conclusion is based on the relatively weak effect of beta-blockers to reduce stroke and the absence of an effect on coronary heart disease when compared to placebo or no treatment. More importantly, it is based on the trend towards worse outcomes in comparison with calcium-channel blockers, renin-angiotensin system inhibitors, and thiazide diuretics. Most of the evidence for these conclusions comes from trials where atenolol was the beta-blocker used (75% of beta-blocker participants in this review). .In younger patients, at about age 50 or under, beta blockers are still an excellent 1'st choice.

 
Old 10-02-2010, 06:06 PM   #9
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

One of the most popular ARB's and supposedly effective drugs, Valsartan (DIOVAN) was found to increase MI as compared to Ace Inhibitor research trials. The Lancet article mentioned that, the interpretation of large scale clinical trials is being increasingly scrutinised by leading journals, with great emphasis being placed on the importance of sharing all potential side effects, no matter how trivial, with patients. The Lancet recently published the results of the valsartan antihypertensive long term use evaluation (VALUE) trial, a study of the effects of reducing blood pressure in patients at high risk. The angiotensin receptor blocker valsartan produced a statistically significant 19% relative increase in the prespecified secondary end point of myocardial infarction (fatal and non-fatal) compared with amlodipine. A doctor who is a patient of one of the authors (SV) commented that if the incidence of myocardial infarction increased with valsartan it would be an essential component of informed consent to share this information when prescribing valsartan for high risk patients with high blood pressure. If Amlodipine is constantly being scrutinized, for Valsartan to be much worse in comparison, does not say much for Valasrtan. If I should switch from a beta blocker, I would probably only consider an Ace Inhibitor and live with the cough and throat tickle.

 
Old 10-02-2010, 11:33 PM   #10
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

Thanks for your input.

This is what has me interested - I ve been taking betaxolol for 7 yrs, and now Im left wondering whether Im benefitting, while living with the side effects, as I cant seem to find much good being said about beta blockers for uncomplicated hypertension.

 
Old 10-03-2010, 10:40 AM   #11
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

I think Betaxolol and Nadolol and Timolol, though not popular, are great drugs. They are used for numerous indications, including glaucoma. According to many articles, they benefit heart function by improving LEV, and all echo cardio. parameters. They are researched and proven for cardiac related problems, and high blood pressure is a cardiac related problem. They are very often prescribed and used by millions. You seem to be doing OK with Betaxolol, compared to other drugs you've tried. The popular and more researched beta blockers are TOPROL, BISOPROLOL and COREG. Bystolic is slowly gaining momentum, though not approved for heart failure in the U.S.

 
Old 10-03-2010, 08:30 PM   #12
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

Agreed. Betaxolol seems to be a good drug. It lowers my bp beautifully and has for 7 yrs, and unless Im exercising I cannot tell that Im taking it.

 
Old 10-04-2010, 08:28 AM   #13
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

You take Betaxolol at 10 mg. a day? That's the dose my doctor told me I should take, if I choose to take Betaxolol. The dosage for Bystolic is usually 5 mg. a day. While Bystolic is OK, It seems that Bystolic, definitely has a negative effect on Cognitive functios. Short term memory is definitely effected. I sometimes have to read something several times for complete understanding. This concerns me. I did not feel that way with Betaxolol.

 
Old 10-04-2010, 07:51 PM   #14
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

Yes, 10mg.. I suppose that dose reduces my systolic about 20 mmHg. If there are cognitive effects with betaxolol (for me), they are quite small, as I dont really notice anything (and I had major cognitive side effects to several other drugs - lisinopril, ARBs, verapamil to name a few).

Last edited by mod-anon; 10-04-2010 at 11:59 PM. Reason: removed quote

 
Old 10-05-2010, 07:15 AM   #15
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Re: Beta Blockers - Has Anyone Switched in Light of Recent Data?

It's true, aside from some beta blockers, many other classes of HBP drugs can cause cognitive side effects. I'm taking Bystolic and recently I took a 4 hour state exam (luckily I passed), but my concentration and memory were definitely affected. Comprehension seemed fuzzy, and my answers seemed rushed. A few years ago, I took another similar exam, at the time I was taking Perindopril and Toprol, I passed that exam also, but my concentration was much sharper, and my answers were not rushed. I also scored more correct answers. Betaxolol seems very similar to Metoprolol in cognitive areas, but some medications can definitely wreak havoc with mental arithmetic.

 
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