Vasodilating Versus First- Generation β-blockers for Cardiovascular Protection Scott Morgan MSIII November 2012.

Slides:



Advertisements
Similar presentations
Post MI Heart Failure with Left Ventricular Dysfunction Management
Advertisements

بسم االله الرحمن الرحيم
Ionotropic Therapy in Acute Heart Failure
BACK TO BASICS: PHARMACOLOGY CHAD C. CRIPE, MD Department of Anesthesiology & Critical Care Medicine Division of Cardiothoracic Anesthesiology The Children’s.
Congestive Heart Failure
Journal Reading Myocardial infarction in young people Cardiol J 2009; 16, 4: 307–311 Cardiol J 2008; 15: 21–25 Presented by R 王郁菁 at ER conference.
Antihypertensives or How not to blow your cork. Background  Cardiovascular pharmacology must always deal with two problems 1. Treating the disease state.
Pharmacology DOR 101 Abdelkader Ashour, Ph.D. 9 th Lecture.
1 Cardiac Pathophysiology Part B. 2 Heart Failure The heart as a pump is insufficient to meet the metabolic requirements of tissues. Can be due to: –
CARDIVASCULAR DRUGS Sanjukta (2009). CARDIOVASCULAR DISEASE AND DRUGS ► Basic cardiovascular physiology and pathology depends on the control of heart.
Pharmacologic Treatment of Chronic Systolic Heart Failure John N. Hamaty D.O. FACC, FACOI.
Beta-Adrenergic Blockers  Types of adrenoceptors Alpha-1  Vasoconstriction  Increased peripheral resistance  Increased blood pressure Alpha-2  Inhibition.
Alpha-Adrenergic Blockers
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 18 Adrenergic Antagonists.
1 Dr. Zahoor Ali Shaikh. 2 CORONARY ARTERY DISEASE (CAD)  CAD is most common form of heart disease and causes premature death.  In UK, 1 in 3 men and.
Drugs for Hypertension
Vasodilating Beta Blockers The New Frontier Abdul H Sankari, MD FACC FCCP.
ADRENERGIC ANTAGONITS
CARDIOVASCULAR DISEASE 1.HYPERTENSION 2.ISCHAEMIC HEART DISEASE 3.THROMBO-EMBOLIC DISEASE Myocardial infarction Stroke Medical Pharmacolgy & Therapeutics.
Nursing Management of Clients with Stressors of Circulatory Function HYPERTENSION NUR133 LECTURE # 10 K. Burger MSEd,MSN, RN, CNE.
Treatment of Heart Failure Claire Hunter, MD. Treatment of Heart Failure Goals Improve quality of life Prolong life Ejection fraction most important.
ACUTE STROKE — Hypertension is a common problem in patients with both type 1 and type 2 diabetes but the time course in relation to the duration.
Adrenergic antagonist sympatholytic
Autoregulation The Renin-angiotensin-aldosterone (RAA) system is an important endocrine component of autoregulation. Renin is released by kidneys when.
CARDIOVASCULAR CARE of the OUTPATIENT Diane M. Enzweiler, MSN, ANP-BC St. Elizabeth Physicians: Heart and Vascular.
Medical Progress: Heart Failure. Primary Targets of Treatment in Heart Failure. Treatment options for patients with heart failure affect the pathophysiological.
ANTI-ADRENERGIC DRUGS
The Renin-Angiotensin System
Pharmacology of Heart failure
Nursing and heart failure
Adrenergic Receptor Antagonists Excessive sympathetic activity is characteristic of a number of pathological states including: Hypertension Angina pectoris.
Angina pectoris Sudden,severe,pressing chest pain starting substernal &radiate to left arm. Due to imbalance between myocardium oxygen requirement and.
Review of an article Not all Angiotension-Converting Enzyme (ACE) inhibitors are Equal: Focus on Ramipril and Perindopril DiNicolantonio J, Lavie C, O’Keefe.
Heart Failure. Background to Congestive Heart Failure Normal cardiac output needed to adequately perfuse peripheral organs – Provide O 2, nutrients, etc.
Drugs Affecting the Cardiovascular System. Cardiovascular System Z Muscular organ with 4 chambers Z Pumps 5-6 liters blood/minute.
Hypertension Family Medicine Specialist CME October 15-17, 2012 Pakse.
Antihypertensive Drugs
Drugs used in angina pectoris
Baseline characteristics. Patient flow Completed Completed Perindopril Placebo Randomised Not randomised Registered.
BETA ADRENOCEPTOR BLOCKERS. OCH 2 CH CH 2 NHCH CH 3 OH CH 2 CH CH 2 NHCH OH CH 3 CH 3 OCHCH 2 PROPRANOLOL METOPROLOL.
بسم الله الرحمن الرحيم.
Heart Failure Heart failure (HF) is a common clinical syndrome. Heart failure (HF) is a complex clinical syndrome that can result from any structural or.
PHARMACOLOGY OF ANS part 3 General Pharmacology M212
Adrenergic Antagonists
 - Adrenoceptors blockers Prof. Hanan Hagar Pharmacology Unit College of Medicine.
Decreasing the Load After the Fill May the Force be with you Clearing the Path Let it Flow
Adrenergic Antagonists (Sympatholytics). Basic stages in synaptic transmission.
1 ADRENERGIC ANTAGONITS. 2 ADRENERGIC BLOCKERS ALPHA BLOCKERS Alpha 1 Blockers Nonselective Alpha Blockers Doxazosin Phenoxybenzamine Prazosin Phentolamine.
Blood Pressure.
Adrenergic Antagonists
Investigation of the effects of ß-blockers on CVS
Heart Failure NURS 241 Chapter 35 (p.797).
Hypertension JNC VIII Guidelines.
Drugs for Hypertension
- Adrenoceptors blockers
Heart Rate, Life Expectancy and the Cardiovascular System: Therapeutic Considerations Cardiology 2015;132: DOI: / Fig. 1. Semilogarithmic.
The pathophysiology of myocardial infarction-induced heart failure
β – ADRENERGIC BLOCKERS
What do I remember? What is atherosclerosis?
Drugs Acting on the Renin-Angiotensin-Aldosterone System
cardiovascular and renal systems
Beta-adrenergic blocking agents
Table of Contents Why Do We Treat Hypertension? Recommendation 5
Effect of β-adrenergic Blockers on the Arterial Blood Pressure
Section III: Neurohormonal strategies in heart failure
CARDIVASCULAR DRUGS.
- Adrenoceptors blockers
Chaper 20 Adrenoceptor Antagonists
Presentation transcript:

Vasodilating Versus First- Generation β-blockers for Cardiovascular Protection Scott Morgan MSIII November 2012

Introduction Hypertension (HTN) Defined as BP >140/90 mmHg Prevalence in US adults is 29% or approximately 59 million Risk factor for several diseases: Cardiovascular (CV) Cerebrovascular Renovascular β-blockers Discovered in mid 1960s Were first-line HTN treatment previously Currently falling out of favor due to side effects

β-blocker Classes GenerationPropertiesExamples FirstNonselective w/o VasodilationPropanolol, pindolol, nadolol, tindolol, sotalol Secondβ1-selective w/o VasodilationAtenolol, bisoprolol, metoprolol ThirdNonselective w/ Vasodilation β1-selective w/ Vasodilation Carvedilol, bucindolol, labetalol Nebivolol

Vasodilating Effects First and Second-Generation (older generation) No vasodilation Third-Generation Nonselective w/ Vasodilation Block vascular α-receptors Carvedilol, bucindolol, labetalol β1-selective w/ Vasodilation Increase NO Nebivolol

1 st Generation Pharmacology Inhibits catecholamines acting on β1-receptors in heart Decreases HR and contractility Leads to decrease CO (SV x HR) and BP Decreases cardiac work and oxygen demand Inhibits β1-receptors on juxtaglomerular apparatus in kidneys Decreases renin release Leads to decreased activation of renin angiotensin aldosterone system (RAAS) Inhibits presynaptic transmission in CNS Decreases catecholamine release

Older Gen Clinical Indications Coronary heart disease Heart failure Reduce mortality by 30% in HF w/o preserved ejection fraction Post-myocardial infarction Prevent catecholamine arrhythmogenic effects such as ventricular tachyarrhymias Chronic stable angina Reduction in cardiovascular events PTs with advanced age LV dysfunction Anterior MI

Older Gen for Blood Pressure Deceased CO Rebound peripheral vasoconstriction to maintain BP Leads to chronic HTN Decreased skeletal muscle perfusion Adverse effects on lipid and glucose metabolism Less effective in elderly and black populations Tend to have low plasma renin HTN Diuretics are more effective Contraindicated in asthmatics β2 effects cause bronchoconstriction Failed to show reduction in myocardium remodeling LVH still occurs similarly to uncontrolled HTN

Compliance Issues Lethargy Drowsiness Depression Peripheral vascular effects Cold extremities Sexual side effects Erectile dysfunction Orgasmic dysfunction Can worsen Diabetes mellitus Decreased insulin release by block β2 receptors in pancreas COPD PVD

Nonselective 3 rd Gen β-blockers Carvedilol, bucindolol, metoprolol Block vascular α-receptors Decreased PVR and increased glucose delivery to muscles Increases insulin sensitivity Normally vasodilates by NO, but vasoconstricts by SNS Diabetes and HTN blunt NO effects allowing SNS to increase PVR Can raise HDL and lower LDL levels Increases renal blood flow Less activation of RAAS Reduces microalbuminuria No negative BUN/creatinine effects

Carvedilol Better tolerated in elderly Body already has β-blocker like effects Decreased β-adrenergic response and increased catecholamine levels Less β-blocking effects and more vasodilation Less sympathetic activation Fewer adverse effects More compliance Most common side effects HA Dizziness Orthostatic hypotension

Nebivolol Highest cardioselectivity of the β blockers Vasodilates Inhibits NADPH oxidase decreased oxygen radical development Produces lower peroxynitrite levels Prevents endothelial cell NO synthesis (eNOS) Increased levels of NO Inhibits platelet aggregation NO normally inhibits aggregation Inhibits atherosclerosis Inhibits edothelin-1 which normally promotes cell growth Increased exercise tolerance compared to traditional β-blockers

β-blocker Properties

Summary Third generation β-blockers are more effective at controlling HTN than traditional More favorable metabolic effects Better choice with multiple comorbid conditions Safer in elderly and black populations Fewer side effects Older generation β-blockers are still useful for treatment of other cardiovascular diseases

Citation Fares, Hassan et al. Vasodilating Versus First-Generation β- blockers for Cardiovascular Protection. Postgraduate Medicine. Volume 124; Issue 2: March, 2011.