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  • Beta Blockers & b/p in Aorta

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    Old 09-09-2007, 08:37 PM   #1
    famnd
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    Beta Blockers & b/p in Aorta

    Found another article concerning this subject. It is a CME for Dr's (I'm not a DR). It says taking our blood pressures on the arm (brachial artery) does give us an accurate reading for the diastolic b/p but not the systolic.

    I'm half way through that study on whether beta blockers cause more problems than they deliver as in strokes & MI's.
    It is tedious reading-have to look up certain points etc that I don't know.

    Flowergirl, please chime in as I know you are reading the same article. Fam

     
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    Old 09-09-2007, 10:20 PM   #2
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    Re: Beta Blockers & b/p in Aorta

    Hi,

    I'll have to read it again. I have not changed my opinion about the beta blockers, in spite of the difficulties they tend to cause me. I am on a tiniest dose of Bisoprolol at the moment as we have run out of options. I am already feeling a difference in how tired I feel. Strangely, my breathing is better on 1/2 dose of the CCB, a small dose of the beta blocker and WITHOUT the Advair.

    FG

     
    Old 09-10-2007, 08:48 AM   #3
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    Re: Beta Blockers & b/p in Aorta

    Since they are two different topics, I'll deal with them separately.

    Central aortic pressure

    It may be more important than peripheral (brachial artery) pressure to the outcomes, such as a stroke and heart disease.
    While the brachial artery diastolic pressure is a good indicator of central aortic diastolic pressure, that's not the case with the systolic pressure.
    Brachial artery systolic does not accurately reflect central aortic systolic pressure. This is noticable especially in patients older than 60 years who are on atenolol specifically.
    The heart and brain are exposed to aortic, not the brachial, pressure. The beta blockers were associated with a smaller reduction in central aortic pressure, compared to other antihypertensives, such as ACE inhibitiors or the calcium channel blockers. Both Norvasc and Amlodipine have been shown to be more effective for lowering central aortic pressure than the atenolol.
    In one recent study, the differences between brachial and aortic pressures averaged 4-5 mm/Hg. In another, the CCBs reduced central aortic pressure by 4.3 mm/Hg, which represents a 20-30% reduction of the risk of stroke. Losartan (an ARB) also outperformed the beta blocker atenolol. In my opinion, though a 5 point difference between brachial and aortic pressures might not seem like an awful lot, the potential reduction of the risk of stroke these five points translate into seems huge and disproportionate. I would say that a person at high risk of a stroke should not rely on the beta blockers exclusively for best protection.

    flowergirl

     
    Old 09-10-2007, 10:12 AM   #4
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    Re: Beta Blockers & b/p in Aorta

    Beta blockers

    Statements that the beta blockers increase the risk of a stroke are misleading. They do not.
    Re-analysis has been done of the meta-analysis. I am sure there's more to follow. It has been shown that in patients under 60, the beta blockers were no different from other antihypertensives in reducing the final outcomes. The patients over 60 had a higher incidence of strokes. Reducing blood pressure is MORE important than the type of a drug that achieves that reduction. Lower blood pressure results in a reduction in the risk of major adverse effects, regardless of the drug used.

    Most patients, including the elderly, require several drugs to reach their BP target. Beta blockers can be used in combination therapy. The evidence does raise some questions about the efficiency of beta blockers as first-line therapy in patients over 60 with primary hypertension and NO OTHER indication for beta blockers. Beta blockers remain a first line therapy for chronic stable angina and post-MI patients. The differences in efficiency noted were with atenolol. When the analysis was restricted to other beta blockers, no such differences were found in comparison with other antihypertensives. They now say that the restricted analysis was most likely underpowered to detect a difference, due to the inclusion of a smaller number of trials with a low number of adverse events. Hmmm....I am sure it's time to re-re-analyse this analysis!
    Everyone seems to agree that beta blockers are less effective than other hypertensives and should not be used as first-line drugs, unless indicated.
    Recently published guidelines of the UK National Institute for Clinical Excellence no longer include beta blockers in their routine treatment for hypertension, citing concerns of lower effectiveness and greater risk of diabetes, especially in combination with thiazide diuretics. They are, however, still considered for patients with uncontrolled or complicated hypertension. The update to the UK hypertension treatment guidelines was the first official update that reflected the results of the recent beta blocker study. Our Canadian guidelines will be updated this fall. I wonder what will be said regarding the use of beta blockers.

    flowergirl

    Last edited by flowergirl2day; 09-10-2007 at 10:18 AM.

     
    Old 09-10-2007, 06:45 PM   #5
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    Re: Beta Blockers & b/p in Aorta

    Thanks so much for your input, FG. I have to finish reading the report. Plus I'm going to go over my PKG insert for Lebetalol etc. I could spend the whole wk before my Dr's app. just reading & thinking about this subject but I don't have a maid, cook etc. so I'm trying to balance it all. I hope my Dr. is up on all this but I wouldn't be surprised if she isn't . Fam

     
    Old 09-10-2007, 09:04 PM   #6
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    Re: Beta Blockers & b/p in Aorta

    Fam,

    try not to worry too much. Talk it out with your doctor and see what she thinks. You said your BP was very good on the 1800mg of Labetalol. That's really what counts and what will keep you safe. I think your dose of Labetalol would knock me right out! I am glad I can tolerate other drugs so, unlike you, don't have to rely so heavily on the beta blockers. Whatever it takes, hey? When will you see your BP doc? I am seeing mine on Friday. Finally!

    FG

     
    Old 09-11-2007, 03:36 AM   #7
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    Re: Beta Blockers & b/p in Aorta

    Quote:
    Originally Posted by flowergirl2day View Post
    .... Both Norvasc and Amlodipine have been shown to be more effective for lowering central aortic pressure than the atenolol....flowergirl
    Just a quickie...amlodipine is the generic of norvasc.

    Bsheba

     
    Old 09-11-2007, 03:40 AM   #8
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    Re: Beta Blockers & b/p in Aorta

    FG

    Thanks so much for the update...having been on some of these meds it's helpful to get this info even if it is after the fact.

    Must do some more reading as I haven't come across this info yet.

    Thanks for keeping us posted!!

    Bethsheba

     
    Old 09-11-2007, 03:42 AM   #9
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    Re: Beta Blockers & b/p in Aorta

    Famnd,

    It sounds like your doctor is receptive to new information that her patients present her with. Is she?

    Bethsheba

     
    Old 09-11-2007, 07:22 AM   #10
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    Re: Beta Blockers & b/p in Aorta

    Quote:
    Just a quickie...amlodipine is the generic of norvasc
    .

    Yes of course it is. I should have caught it, as I've been on both. I read several studies, physicians comments and subsequent analytical write-ups. It's a wonder I was able to think straight at all by the time I finished! I just missed it. Thank you for the correction.

    flowergirl

     
    Old 09-17-2007, 06:15 PM   #11
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    Re: Beta Blockers & b/p in Aorta

    Thanks, FG for all the info. I finished reading that article plus read a few others. The key issues that are a problem are decrease in metablic rate, increase in blood sugar, inability to exercise to protect the heart, weigh gain etc.

    My blood studies have not increased probably because of all the exercise I do. Wt. gain is where I need to really put in more effort. Cutting calories is the only way to do that.

    Coreg was mentioned as an alternative for those of us who have to take a beta blocker. I looked at it again but there are too many red flags for me. Since I already take a apha/beta blocker, I should be better off than with a pure beta blocker.

    Although I have a strong family history of hypertension, only two had a stroke (small one) & that was when she was 85yrs. My one aunt who had the highest bp lived to 94 & died from a urinary tract infection. She did have a small stroke at 87yrs. It's not too unusual to have a stroke in one's 80's. My mother's hypertension decreased dramatically in her 60's so she had to stop her meds. She didn't smoke etc & ate healthy. So I'm not too worried just want to do all I can to maintain my health. Fam

     
    Old 09-17-2007, 09:01 PM   #12
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    Re: Beta Blockers & b/p in Aorta

    I am told that:

    -being on a beta blocker gives some protection in heart disease

    -ditto for Lipitor, also helps with narrowed arteries

    -ditto for Aspirin (prevents blood clots)

    -same with heart healthy diet & exercise, with emphasis on cardio, helps with plaque & reverses remodelling over time

    I think that there's only so much a person can do. There's no stroke history in my family, either, just a lot of hypertension and some cardio stuff. I think you are doing plenty! You exercise a lot. You watch what you eat. I will try to do more. Maybe I can slowly build up some exercise tolerance, or learn to maintain my breathing. As you know, it's hard for those on a beta blocker, even without breathing problems.
    We cannot do much about the natural decrease in metabolic rate, which is a part of aging. My ACE inhibitor should counter any potential increases in blood sugar that result from the use of the betas. Like you, because I cannot exercise as much as I'd like, I try to make up for it by not consuming foods high in calories (unless they are very nutritious, like walnuts), or alcohol. By doing this I hope to minimize any potential weight gain from the beta blockers or my other medications with that potential.
    You will soon have to decide whether or not to continue with your therapy. Your medication is appropriate in treating resistant and difficult hypertension, regardless of age. You now have an excellent blood pressure control, which, of course, is the bottom line. Looks to me as if you've given this careful consideration and made your decision.(I tend to agree ) I know you will consult with your specialist in just a few days. I hope you'll share what his opinion on this matter is - I'd be very interested in hearing it. Your case is unique and challenging because of the other existing conditions and the yellow dye intolerance.

    flowergirl

     
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