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Muresan L, Rosu R, Cismaru G, Gusetu G, Muresan C, Martins RP, Popa S, Levy J, Tranca S. Nebivolol for the Treatment of Arrhythmias: a Narrative Review. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022. [DOI: 10.1007/s11936-022-00970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Koracevic G, Stojanovic M, Lovic D, Zdravkovic M, Sakac D. Certain beta blockers (e.g., bisoprolol) may be reevaluated in hypertension guidelines for patients with left ventricular hypertrophy to diminish the ventricular arrhythmic risk. J Hum Hypertens 2021; 35:564-576. [PMID: 33654234 DOI: 10.1038/s41371-021-00505-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
Hypertensive left ventricular hypertrophy (HTN LVH) is associated with almost threefold increased risk of ventricular tachycardia (VT)/ventricular fibrillation (VF). Furthermore, HTN LVH increases the risk of sudden cardiac death (SCD). The reverse LV remodeling due to efficient antihypertensive therapy lowers the incidence rates of cardiovascular events and SCD and the vast majority of available arterial hypertension (HTN) guidelines recommend renin angiotensin system (RAS) blockers and calcium channel blockers (CCBs) for HTN LVH aiming for LVH regression. On the other hand, beta blockers (BBs) as a class are not recommended in HTN LVH due to their insufficient capacity to reverse LVH remodeling even though they are recommended as the first-line drugs for prevention/treatment of VT/VF (in general, unrelated to HTN LVH). Moreover, BBs are the best antiarrhythmic (against VT/VF) among antihypertensive drugs. Despite that, BBs are currently not recommended for LVH treatment in HTN Guidelines. It is important to prevent VT/VF in patients at high risk, such as those with HTN LVH. Therefore, certain BBs (such as Bisoprolol) may be reevaluated in guidelines for HTN (in the section of HTN LVH).
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Affiliation(s)
- Goran Koracevic
- Department for Cardiovascular Diseases, Clinical Center Nis, Nis, Serbia.,Faculty of Medicine, University of Nis, Nis, Serbia
| | | | - Dragan Lovic
- Clinic for Internal Diseases Inter Medica, Nis, Serbia.,Singidunum University, School of Medicine, Belgrade, Serbia
| | - Marija Zdravkovic
- University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia
| | - Dejan Sakac
- Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica & Medical Faculty Novi Sad, Novi Sad, Serbia
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Çetin M, Turfan N, Karaman K, Yaşar AŞ, Güven B, Tunçdemir P. The Pattern of Tpeak-Tend Interval and QTdis, and Pdis in Children with Brucellosis. J Trop Pediatr 2019; 65:474-480. [PMID: 30624756 DOI: 10.1093/tropej/fmy078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the effect of inflammation on the conducting system of the heart in patients diagnosed with brucellosis. METHODS A total of 42 patients diagnosed with brucellosis and 39 age and sex-matched healthy children were enrolled into the study. Pre- and post-treatment electrocardiographic parameters in brucellosis and control group were recorded from an electrocardiogram for each patient. RESULTS The results indicated that the parameters including Pmax, Pdis, QTmax, QTdis, QTcdis, Tp-edis interval and Tp-emax/QTmax and Tp-emax/QTcmax ratios, which are known to be key indicators for the prediction of severe atrial or ventricular arrhythmia and sudden cardiac death and also important parameters used as the indicators for the non-invasive evaluation of the transmural heterogeneity were significantly longer in the study group compared with the control group (p < 0.05). CONCLUSION In this study, it was determined that the brucella disease had more cardiac involvement than thought, and this was more in the subclinical form of cardiac involvement.
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Affiliation(s)
- Mecnun Çetin
- Department of Pediatric Cardiology, Van Yuzuncu Yil Universitiy, Van, Turkey
| | - Nevzat Turfan
- Department of Pediatrics, Van Yuzuncu Yil Universitiy, Van, Turkey
| | - Kamuran Karaman
- Department of Pediatric Hematology, Van Yuzuncu Yil Universitiy, Van, Turkey
| | - Akkız Şahin Yaşar
- Department of Pediatric Hematology, Van Yuzuncu Yil Universitiy, Van, Turkey
| | - Burcu Güven
- Department of Pediatric Gastroenterology, Van Yuzuncu Yil Universitiy, Van, Turkey
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Bai Y, Chen X. A mild synthesis of α,α′-[iminobismethylene]bis[6-fluoro-3,4-dihydro-2H-1-benzopyran-2-methanol]. JOURNAL OF CHEMICAL RESEARCH 2019. [DOI: 10.3184/030823406780199802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A new synthesis of α,α′-[iminobismethylene]bis[6-fluoro-3,4-dihydro-2 H-1-benzopyran-2-methanol (1) is described, with most reactions being carried out at room temperature and normal pressure, that will further contribute to the development of new scalable synthesis of the related drug substance of Nebivolol (overall yield: 33%).
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Affiliation(s)
- Yihui Bai
- College of Materials Science and Chemical Engineering, Zhejiang University, Hangzhou 310027, P.R. China
- College of Science of Chemistry and Life Science, Zhejiang Normal University, Jinhua 321004, P.R. China
| | - Xinzhi Chen
- College of Materials Science and Chemical Engineering, Zhejiang University, Hangzhou 310027, P.R. China
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5
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Modulation of the QT interval duration in hypertension with antihypertensive treatment. Hypertens Res 2015; 38:447-54. [DOI: 10.1038/hr.2015.30] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/27/2014] [Accepted: 11/12/2014] [Indexed: 11/08/2022]
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Varagic J, Punzi H, Ferrario CM. Clinical utility of fixed-dose combinations in hypertension: evidence for the potential of nebivolol/valsartan. Integr Blood Press Control 2014; 7:61-70. [PMID: 25473311 PMCID: PMC4251532 DOI: 10.2147/ibpc.s50954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Despite significant advances in pharmacologic approaches to treat hypertension during the last decades, hypertension- and hypertension-related organ damage are still a high health and economic burden because a large proportion of patients with hypertension do not achieve optimal blood pressure control. There is now general agreement that combination therapy with two or more antihypertensive drugs is required for targeted blood pressure accomplishment and reduction of global cardiovascular risk. The goals of combination therapies are to reduce long-term cardiovascular events by targeting different mechanism underlying hypertension and target organ disease, to block the counterregulatory pathways activated by monotherapies, to improve tolerability and decrease the adverse effects of up-titrated single agents, and to increase persistence and adherence with antihypertensive therapy. Multiple clinical trials provide evidence that fixed-dose combinations in a single pill offer several advantages when compared with loose-dose combinations. This review discusses the advances in hypertension control and associated cardiovascular disease as they relate to the prospect of combination therapy targeting a third-generation beta (β) 1-adrenergic receptor (nebivolol) and an angiotensin II receptor blocker (valsartan) in fixed-dose single-pill formulations.
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Affiliation(s)
- Jasmina Varagic
- Hypertension and Vascular Research Center, Wake Forest University, Winston-Salem, NC USA ; Division of Surgical Sciences, Wake Forest University, Winston-Salem, NC USA ; Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC USA
| | - Henry Punzi
- Trinity Hypertension and Diagnostic Research Center, Carrollton, TX, USA ; Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carlos M Ferrario
- Division of Surgical Sciences, Wake Forest University, Winston-Salem, NC USA ; Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC USA ; Department of Internal Medicine and Nephrology, Wake Forest University, Winston-Salem, NC, USA
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Ceker Z, Takmaz SA, Baltaci B, Başar H. [The effect of esmolol on corrected-QT interval, corrected-QT interval dispersion changes seen during anesthesia induction in hypertensive patients taking an angiotensin-converting enzyme inhibitor]. Rev Bras Anestesiol 2014; 65:34-40. [PMID: 25497747 DOI: 10.1016/j.bjan.2014.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/19/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The importance of minimizing the exaggerated sympatho-adrenergic responses and QT interval and QT interval dispersion changes that may develop due to laryngoscopy and tracheal intubation during anesthesia induction in the hypertensive patients is clear. Esmolol decreases the hemodynamic response to laryngoscopy and intubation. However, the effect of esmolol in decreasing the prolonged QT interval and QT interval dispersion as induced by laryngoscopy and intubation is controversial. We investigated the effect of esmolol on the hemodynamic, and corrected-QT interval and corrected-QT interval dispersion changes seen during anesthesia induction in hypertensive patients using angiotensin converting enzyme inhibitors. METHODS 60 ASA I-II patients, with essential hypertension using angiotensin converting enzyme inhibitors were included in the study. The esmolol group received esmolol at a bolus dose of 500mcg/kg followed by a 100mcg/kg/min infusion which continued until the 4th min after intubation. The control group received 0.9% saline similar to the esmolol group. The mean blood pressure, heart rate values and the electrocardiogram records were obtained as baseline values before the anesthesia, 5min after esmolol and saline administration, 3min after the induction and 30s, 2min and 4min after intubation. RESULTS The corrected-QT interval was shorter in the esmolol group (p=0.012), the corrected-QT interval dispersion interval was longer in the control group (p=0.034) and the mean heart rate was higher in the control group (p=0.022) 30s after intubation. The risk of arrhythmia frequency was higher in the control group in the 4-min period following intubation (p=0.038). CONCLUSION Endotracheal intubation was found to prolong corrected-QT interval and corrected-QT interval dispersion, and increase the heart rate during anesthesia induction with propofol in hypertensive patients using angiotensin converting enzyme inhibitors. These effects were prevented with esmolol (500mcg/kg bolus, followed by 100mcg/kg/min infusion). During induction, the blood pressure tends to decrease with esmolol where care is needed.
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Affiliation(s)
- Zahit Ceker
- Departamento de Anestesiologia e Reanimação, Ankara Training and Research Hospital, Ministry of Health, Ankara, Turquia
| | - Suna Akın Takmaz
- Departamento de Anestesiologia e Reanimação, Ankara Training and Research Hospital, Ministry of Health, Ankara, Turquia.
| | - Bülent Baltaci
- Departamento de Anestesiologia e Reanimação, Ankara Training and Research Hospital, Ministry of Health, Ankara, Turquia
| | - Hülya Başar
- Departamento de Anestesiologia e Reanimação, Ankara Training and Research Hospital, Ministry of Health, Ankara, Turquia
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Suzuki K, Numaguchi A, Adachi YU, Obata Y, Hatano T, Ejima T, Sato S, Matsuda N. Continuous administration of landiolol reduced QT dispersion in postoperative patients. J Clin Anesth 2014; 26:438-42. [PMID: 25204509 DOI: 10.1016/j.jclinane.2014.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 01/22/2014] [Accepted: 01/30/2014] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To determine the changes in QT dispersion (QTD) in the standard electrocardiogram (ECG) of postoperative patients and the effect of landiolol on QTD. DESIGN Randomized, prospective, double-blinded study. PATIENTS 40 postsurgical patients. INVENTIONS Patients were allocated to three groups: Control group patients (Group C) were administered saline and patients in the landiolol groups (Group L2 and Group L5) were infused landiolol 2 μg/kg/min and 5 μg/kg/min, respectively. All infusions were started at midnight and discontinued at 6 o'clock in the morning. MEASUREMENTS Heart rate (HR), systolic (SBP) and diastolic (DBP) invasive blood pressure, and ECG were recorded at 0 (immediately before infusion), at 3 o'clock, and 6 o'clock (immediately before termination). The ECG wave was recorded electronically and QTD was analyzed using PC software. Heart rate, blood pressure, QT interval, and QTD were compared as changes from baseline values. MAIN RESULTS In Groups L2 and L5, HR was significantly decreased, approximately 10 bpm. Both SBP and DBP showed a decreasing trend at 3 o'clock. Absolute QT interval was prolonged in all groups; however, the decrease in QTD occurred in Group L5. CONCLUSIONS Continuous administration of landiolol prevents the increase in QTD found on the morning in postoperative patients. Landiolol demonstrated a possible antiarrhythmic effect by improving the imbalance of repolarization.
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Affiliation(s)
- Katsumi Suzuki
- Department of Anesthesia, Koseiren Enshu Hospital, Hamamatsu, 430-0929, Japan
| | - Atsushi Numaguchi
- Department of Emergency Medicine, Nagoya University Hospital, Showa-ku, Nagoya City, Aichi, 466-8550, Japan
| | - Yushi U Adachi
- Department of Emergency Medicine, Nagoya University Hospital, Showa-ku, Nagoya City, Aichi, 466-8550, Japan.
| | - Yukako Obata
- Department of Anesthesia and Resuscitation, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Toshiyuki Hatano
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Tadashi Ejima
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Shigehito Sato
- Department of Anesthesia and Resuscitation, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Naoyuki Matsuda
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
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Buttà C, Tuttolomondo A, Casuccio A, Di Raimondo D, Giarrusso L, Miceli G, Lo Vecchio S, Canino B, Licata G, Pinto A. Use of QT intervals for a more accurate diagnose of syncope and evaluation of syncope severity. Int J Clin Pract 2014; 68:864-70. [PMID: 24548671 DOI: 10.1111/ijcp.12387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the use of QT intervals, their diagnostic predictive value in patients with syncope and their relationship with syncope severity. METHODS One hundred and forty nine patients with a diagnosis of syncope were admitted to Internal Medicine departments at the University of Palermo, Italy, between 2006 and 2012, and 140 control subjects hospitalised for other causes were enrolled. QT maximum, QT minimum, QTpeak, QT corrected, QT dispersion and Tpeak-to-Tend interval were compared between two groups. The paper medical records were used for scoring with San Francisco Syncope Rule (SFSR), Evaluation of Guidelines in SYncope Study (EGSYS) score and Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score. RESULTS Mean QTc (p < 0.0005), mean QTmax (p < 0.0005), mean QTdisp (p < 0.0005), mean QTpeak (p = 0.005) and mean TpTe (p = 0.018) were significantly longer in patients with syncope compared with control subjects. A QTc > 424.8 ms (sensibility: 81.88 - specificity: 57.86) showed the greatest predictive value for diagnosis of syncope. On the EGSYS score and on the OESIL score, QTc was significantly prolonged in high-risk patients compared with low-risk patients. On the San Francisco Syncope Rule, QTc and QTdisp were significantly prolonged in high-risk patients compared with low-risk patients. CONCLUSION Mean QTc, mean QTdisp, mean TpTe, mean QTmax and mean QTpeak were significantly longer in patients with syncope compared with control subjects. Furthermore, prolonged QTc and QTdisp were associated with major severe syncope according to San Francisco Syncope Rule, EGSYS and OESIL risk scores.
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Affiliation(s)
- C Buttà
- U.O.C. Medicina Vascolare, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di, Palermo, Italy
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Kunisek J, Zaputovic L, Cubranic Z, Kunisek L, Zuvic Butorac M, Lukin-Eskinja K, Karlavaris R. Influence of the left ventricular types on QT intervals in hypertensive patients. Anatol J Cardiol 2014; 15:33-9. [PMID: 25179883 PMCID: PMC5336895 DOI: 10.5152/akd.2014.5134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective: To investigate the possible electrophysiological background of the greater excitability of concentric and eccentric left ventricular hypertrophy types in relation to the asymmetric type. Methods: 187 patients with essential hypertension, without ishaemic heart disease were divided into three groups with regard to left ventricule type: concentric (relative wall thickness >0.42, interventricular septum/left ventricular posterior wall ≤1.3), eccentric (left ventricular diameter in systoles >32, relative wall thickness <0.42), asymmetric left ventricular hypertrophy (interventricular septum/left ventricular posterior wall >1.3), and three subgroups: mild (interventricular septum or left ventricular posterior wall 11-12 mm), moderate (interventricular septum or left ventricular posterior wall 13-14 mm) and severe left ventricular hypertrophy (interventricular septum or left ventricular posterior wall ≥15 mm). In all patients QT intervals, QT dispersion, left ventricular mass index and ventricular arrhythmias were measured. An upper normal limit for QT corrected interval: 450/460 ms for men/women; for QT dispersion: 70 ms. Results: The QT corrected interval and QT dispersion were increased in severe concentric and eccentric left ventricular hypertrophy (443 and 480 ms for QT corrected; 53 and 45 ms for QT dispersion, respectively), not significantly. QT dispersion in men with severe left ventricular hypertrophy was significantly enlarged (67.5 vs. 30 ms, p=0.047). QT interval was significantly longer in patients with complex ventricular arrhythmias (p=0.037). Conclusion: No significant association of QT intervals or QT dispersion with the degree/type of left ventricular hypertrophy was found. QT corrected interval and QT dispersion tend to increase proportionally to the left ventricular mass only in the concentric and eccentric type.
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Affiliation(s)
- Juraj Kunisek
- Thalassotherapia Crikvenica, Special Hospital for Medical Rehabilitation; Crikvenica-Croatia.
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Antonakis V, Tsioufis C, Tsiachris D, Andrikou I, Fantaki M, Dagres N, Vrachnis N, Stefanadis C. Associations of Hemodynamic Load and Ventricular Repolarization in Patients With Newly Diagnosed Essential Hypertension: A Long-Term Follow-Up Study. J Clin Hypertens (Greenwich) 2014; 16:219-24. [DOI: 10.1111/jch.12275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/20/2013] [Accepted: 12/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Velissaris Antonakis
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Costas Tsioufis
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Dimitris Tsiachris
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Ioannis Andrikou
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Maria Fantaki
- Second Cardiology Department; University of Athens; Attikon University Hospital; Athens Greece
| | - Nikos Dagres
- Second Cardiology Department; University of Athens; Attikon University Hospital; Athens Greece
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Effects of resveratrol and nebivolol on isolated vascular and cardiac tissues from young rats. Adv Pharmacol Sci 2014; 2014:720386. [PMID: 24696678 PMCID: PMC3950595 DOI: 10.1155/2014/720386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/06/2014] [Indexed: 11/17/2022] Open
Abstract
The mechanisms by which resveratrol and nebivolol induce vasodilation are not clearly understood. It has been postulated that both agents stimulate the production of nitric oxide; however, this remains to be conclusively established. The major aim of this study was to examine the vasodilatory and antiarrhythmic effects of both resveratrol and nebivolol and to provide further insight into possible mechanisms of action. Cardiac and vascular tissues were isolated from healthy male rodents. Results indicate that resveratrol and nebivolol decrease the action potential duration and induce mild vasorelaxation in aortic and mesenteric segments. Relaxation induced by resveratrol was prevented by the addition of verapamil, N ω -nitro-L-arginine-methyl ester, and 4-aminopyridine. This suggests that nebivolol and resveratrol act as putative antiarrhythmic and vasodilatory agents in vitro through possible indirect nitric oxide mechanisms.
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Aksoy SM, Cay S, Cagirci G, Sen N. Nebivolol therapy improves QTc and QTcd parameters in heart failure patients. Cardiovasc J Afr 2013; 23:191-3. [PMID: 22614660 PMCID: PMC3721958 DOI: 10.5830/cvja-2011-046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 08/30/2011] [Indexed: 11/28/2022] Open
Abstract
Aim It has previously been shown that β-blocker therapy reduces QT dynamics in heart failure patients. The aim of this study was to demonstrate this improvement with the third-generation β-blocker, nebivolol. Methods A total of 72 heart failure patients with systolic dysfunction were included in the study. Corrected QT (QTc) and QT dispersion (QTcd) were measured manually by two independent observers at baseline and after nebivolol use (5 mg/day) in the first and third months of follow up. Results Both QTc and QTcd were found to be significantly reduced in the first (455.3 ± 26.7 vs 441.2 ± 25.7 ms, p < 0.001 for QTc, and 65.6 ± 5.3 vs 58.2 ± 5.6 ms, p = 0.001 for QTcd) and third months (455.3 ± 26.7 vs 436.0 ± 28.7 ms, p < 0.001 for QTc, and 65.6 ± 5.3 vs 56.0 ± 6.2 ms, p < 0.001 for QTcd) compared with baseline values. Conclusion Nebivolol was associated with improved QT dynamics in heart failure patients with systolic dysfunction.
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Affiliation(s)
- S M Aksoy
- Department of Anesthesiology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
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Münzel T, Gori T. Nebivolol: the somewhat-different beta-adrenergic receptor blocker. J Am Coll Cardiol 2009; 54:1491-9. [PMID: 19815121 DOI: 10.1016/j.jacc.2009.05.066] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 05/06/2009] [Indexed: 11/26/2022]
Abstract
Although its clinical use in Europe dates almost 10 years, nebivolol is a beta-blocker that has been only recently introduced in the U.S. market. Like carvedilol, nebivolol belongs to the third generation of beta-blockers, which possess direct vasodilator properties in addition to their adrenergic blocking characteristics. Nebivolol has the highest beta(1)-receptor affinity among beta-blockers and, most interestingly, it substantially improves endothelial dysfunction via its strong stimulatory effects on the activity of the endothelial nitric oxide synthase and via its antioxidative properties. Because impaired endothelial activity is attributed a major causal role in the pathophysiology of hypertension, coronary artery disease, and congestive heart failure, the endothelium-agonistic properties of nebivolol suggest that this drug might provide additional benefit beyond beta-receptor blockade. Although lesser beta-blocker-related side effects have been reported in patients with chronic obstructive pulmonary disease or impotence taking nebivolol, side effects and contraindications overlap those of other beta-blockers. Clinically, this compound has been proven to have antihypertensive and anti-ischemic effects as well as beneficial effects on hemodynamics and prognosis in patients with chronic congestive heart failure. Further studies are now necessary to compare the benefit of nebivolol with that of other drugs in the same class and, most importantly, its prognostic impact in patients with hypertension.
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Affiliation(s)
- Thomas Münzel
- II Medizinische Klinik für Kardiologie/Angiologie, Langenbeckstrasse 1, Mainz, Germany.
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15
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Abstract
β-blockers are among the most widely used drugs in the prevention and treatment of cardiovascular disease, although they are associated with increased peripheral resistance. Third-generation β-blockers avoid this adverse effect by inducing vasodilation through different mechanisms. In particular, nebivolol, a highly selective blocker of β1-adrenergic receptors, is the only β-blocker known to induce vascular production of nitric oxide, the main endothelial vasodilator. The specific mechanism of nebivolol is particularly relevant in hypertension, where nitric oxide dysfunction occurs. Indeed, nebivolol is able to reverse endothelial dysfunction. Nebivolol induces nitric oxide production via activation of β3-adrenergic receptors, which can explain the good metabolic profile observed after treatment with this drug. Moreover, nebivolol can also stimulate the β3-adrenergic receptor-mediated production of nitric oxide in the heart, and this stimulation can result in a greater protection against heart failure. In conclusion, nebivolol has a unique profile among antihypertensive drugs, adding to a very high selectivity against β1 adrenergic receptors, and an agonist action on β3 receptors and nitric oxide (NO), which has led to clinically significant improvements in hypertensive patients.
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Affiliation(s)
- Angelo Maffei
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Giuseppe Lembo
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli (IS), Italy,
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Dimopoulos S, Nicosia F, Donati P, Prometti P, De Vecchi M, Zulli R, Grassi V. QT dispersion and left ventricular hypertrophy in elderly hypertensive and normotensive patients. Angiology 2008; 59:605-12. [PMID: 18388029 DOI: 10.1177/0003319707310276] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Inhomogeneity of ventricular repolarization as detected by QT dispersion may be a potential leading mechanism of sudden death in hypertensive and normotensive (age related) left ventricular hypertrophy. Aim of this study was to investigate QT dispersion, ventricular arrhythmias, and left ventricular mass index in elderly hypertensive and normotensive patients. Study population consisted of 60 consecutive patients (sex: 34 men/26 women; age: 63 +/- 11 years) with essential arterial hypertension and 48 age and sex-matched control subjects (24 men/24 women; 64 +/- 16 years). Measurements included QTc dispersion, ventricular arrhythmias, and left ventricular hypertrophy. Hypertensive patients had greater left ventricular mass index (P = .006) and higher QTc dispersion (P = .004) than controls. Left ventricular hypertrophy was diagnosed in 57 (31 men/26 women) of all subjects. These patients had higher blood pressure (P < .05), Lown's score (P < .001), and QTc dispersion (P < .001). QTc dispersion and Lown's score were independent predictors of left ventricular mass index (P < .001). Conclusively, QTc dispersion is a strong indicator of left ventricular mass index and might be used in risk stratification of hypertensive and normotensive elderly patients.
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Affiliation(s)
- Stavros Dimopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece.
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Abstract
Nebivolol is a third generation beta-blocker. It is highly selective for the beta1-adrenoceptor, and has additional nitric oxide-mediated vasodilating and antioxidant properties, along with a favourable metabolic profile. Nebivolol is well tolerated by patients with hypertension and heart failure. Although several smaller studies were conducted with nebivolol in hypertensive patients, no large randomised clinical trials have been performed to prove efficacy on hard clinical end points. In patients with heart failure, a large mortality/morbidity trial was conducted, and nebivolol was shown to reduce the composite end point of mortality and hospitalisations. Nebivolol is registered, in Europe, for mild-to-moderate, uncomplicated hypertension and mild-to-moderate heart failure; and outside Europe, for hypertension. This review describes experimental and clinical data regarding this selective beta-blocker with vasodilating and antioxidant effects.
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Affiliation(s)
- Rudolf A de Boer
- University Medical Center Groningen, Thoraxcenter, Department of Cardiology, Groningen, The Netherlands
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