Discussions that mention toprol

High & Low Blood Pressure board

Hi Beerzoids,

I am sure you've done plenty of research before deciding to add this beta blocker to your therapy. I would have done the same. My book about cardiovascular pharmacotherapeutics has some interesting information that might explain your rise in blood pressure upon initiating the beta blocker therapy.

Apparently, non-selective beta blockers can cause peripheral resistance to rise by leaving alpha stimulatory mechanism unopposed. They say that one should ask if there's a clinical correlation between the beta blocking effect on the plasma renin activity and the lowering of blood pressure. :confused:
High renin patients do not respond to beta blockers and may even show a RISE in blood pressure.

Some beta blocking drugs can antagonize symphahetically mediated renin release. (one of several mechanisms utilized in the release of renin). Other major factors are renal perfusion pressure, posture and a sodium balance. The COMET trial with Carvedilol and Metoprolol is mentioned here. There is also a long list of possible mechanisms by which the ventricular function is thought to be improved with the use of this drug in heart failure. The beta blockers' effectiveness lies in blocking the neurohormonal cascade which leads to progression of the disease.
The beta blocker I take, Bisoprolol, is also approved for use in heart failure. Spironolactone, an aldosterone antagonist, is supposed to be helpful in treating CHF. I take 5mg of Bisoprolol, which is not a very high dose. It does not interfere with my breathing at this dose the way the non-selective beta blockers do. I wouldn't know what (if any) side effects I might be experiencing from this drug because of the other drugs I also take. Probably shortness of breath if I exert myself too much - which I try very hard not to do. :D
I wish you the best of luck with Carvedilol - it seems like a perfect drug with very impressive results in the trials. I hope your blood pressure levels off and eventually gets back to normal.

Nebivolol, recently approved by the FDA for treating hypertension (Dec.17/07) is the most beta1 selective beta blocker. This usually means reduced side effects. Nebivolol also has nitric oxide vasodilating and antioxidant properties.

Carvedilol (Coreg) is a non-selective beta2 blocker. It causes vasodilation through alpha1 receptor blockade.

In hypertension, the most effective combination of these new generation beta blockers is with a diuretic and a CCB. They do not work nearly as well in reducing blood pressure when combined with ACE inhibitors or ARBs. Such combinations are sometimes used for other purposes. Nebivolol is approved and used for hypertension and heart failure in Europe. A lot of data is available. (SENIORS trial). European heart failure guidelines recommend carvedilol, bisoprolol, nebivolol and XR metoprolol for use in heart failure.

A small study was done with 160 hypertensive CHF patients (class II or III). In this study, both Nebivolol and Carvedilol were used with interesting results. An improvement in an ejection fraction of about 5% was seen at the end of a two year period in each group of people, using either of these two drugs. More studies are needed, but the fact remains that these beta blockers are an effective form of treatment in heart failure, regardless of their selectivity. :)

I'll look for the blood pressure connection tomorrow.

I am so glad you've had further blood pressure reductions. As you pointed out, it is a matter of finding the best medication, whose effects on the body are enhanced and complimented by a vigorous exercise regimen and a very healthy diet.

It is always good to have choices. The more, the better. It is nice to have several beta blockers to choose from. I did some reading about how well Coreg, Bisoprolol and Toprol XL had performed in the clinical trials and subsequent studies. Most trials were ended way before the scheduled completion dates, because the effectiveness of beta blockers in CHF was undisputable. Coreg achieved the best results in reducing blood pressure - perhaps because of the incorporated alpha blocker. EF has been shown to improve in the first 4 months of Coreg use as much as it was going to. Heart size continues to improve over a longer period of time. The only drawback seems to be a frequent upper respiratory tract infection when starting Coreg. The tiredness and lack of enthusiasm - as you describe them - are both very common side effects, probably more pronounced in CHF. Do not be surprised if you find your exercise tolerance affected. Beta blockers are known for that.

Thanks for your update! :)