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Medical Forum / General / Cardiology / August 2007beta-blockers
Doctors urged to curb reliance on beta-blockers Research favors other drugs to control hypertension By Stephen Smith, Globe Staff | August 7, 2007 Doctors should stop routinely using beta-blockers to control high blood pressure, said researchers who reviewed dozens of previously published studies and found that other hypertension pills work better and cause fewer side effects. For decades, beta-blockers and diuretics, also known as water pills, constituted the cornerstone of treatment for the 50 million Americans with high blood pressure. But a growing body of medical evidence shows that diuretics and newer blood-pressure medications are superior to beta-blockers at reducing high blood pressure, which can lead to heart attacks and strokes, said researchers whose report appeared yesterday in the Journal of the American College of Cardiology. "We in medicine like to say that we practice evidence-based medicine," said Dr. Franz H. Messerli, an author of the study and a cardiologist at St. Luke's-Roosevelt Hospital in New York. "What's the evidence here" for continued use of beta-blockers to treat hypertension, Messerli asked. "Zero. To my way of thinking, this is pretty alarming." Heart specialists not involved with the study predicted that it is likely to accelerate a shift in hypertension treatment from beta- blockers, which can cause side effects such as fatigue and sexual dysfunction. Still, those doctors as well as the authors of the study emphasized that there is strong evidence to support prescribing beta-blockers for patients who have suffered a heart attack or those with a progressive weakening condition called heart failure. Data from IMS Health, a healthcare information company, show that from January through June of this year, more than 75 million prescriptions were written for various beta-blockers, widely available in generic form. The statistics do not indicate which conditions the doctors were treating. European medical societies have already begun urging physicians to abandon beta-blockers as a high blood-pressure medication, specialists said. "I think this paper is going to be fairly influential, although I think the trend had already started before this of moving away from beta-blockers as a first-line treatment of hypertension," said Dr. Joseph Carrozza, chief of interventional cardiology at Beth Israel Deaconess Medical Center. "The side effects are probably the worst" of any medication used to treat high blood pressure, he said. Cardiologists said there is no clear culprit for the heavy use of beta- blockers. Early research suggested that the drugs had promise in treating high blood pressure, though they were often used with diuretics, which turned out to provide much of the benefit. Also, beta-blockers have been around for decades and in recent years, their patents had expired, so they were relatively inexpensive, doctors said. "This is just another example of why we need to do continuing follow- up research on classes of medicine," said Alan Goldhammer, deputy vice president for regulatory affairs at PhRMA, a leading pharmaceutical industry association. One possible limitation in the new research: It was based on previous studies that looked at older beta-blockers, rather than some recently introduced formulations. Still, Dr. Ilke Sipahi, a cardiologist at the Cleveland Clinic, said "until further data comes out, I think it's prudent not to use beta- blockers as a first-line treatment of high blood pressure." The National Heart, Lung, and Blood Institute had already planned to convene specialists this fall to draft sweeping guidelines directing physicians toward the best treatments for their patients with cardiovascular ailments. Dr. Lawrence J. Fine, acting chief of the national agency's Clinical Applications and Prevention Branch, said the new study will be factored into those recommendations. "Clearly, these authors have raised issues that new assessments of guidelines will have to consider seriously," Fine said. In patients with high blood pressure, once-flexible blood vessels have turned rigid, meaning more pressure is needed to propel blood through veins and arteries. To treat the condition, doctors use four major classes of high blood pressure pills: beta-blockers, diuretics, calcium-channel blockers, and ACE inhibitors. Beta-blockers, sold under trade names such as Lopressor and Tenormin, work by blocking the effect of the hormone adrenaline on the heart. As a result, the heart slows down and does not have to work as hard. That's especially useful in the treatment of patients who have suffered heart attacks and those whose hearts chronically malfunction. While beta-blockers reduce blood pressure, the other drugs do so more effectively and with fewer complications, the authors of yesterday's study said. For example, the researchers cite an earlier analysis of 10 medical studies involving elderly patients with high blood pressure. About two- thirds of the patients taking diuretics had their blood pressure controlled, compared with less than one-third of the patients on beta- blockers. Diuretics, among the most affordable drugs patients can take, reduce blood pressure by helping the body excrete excess water and sodium. They are widely regarded as the preferred first-line treatment for blood pressure patients, because of their low cost and mild side effects. The later-generation drugs -- calcium-channel blockers and ACE inhibitors -- relax blood vessel walls, allowing blood to flow more smoothly. While high blood pressure patients taking beta-blockers have a reduced risk of stroke of 16 percent to 22 percent compared with a placebo, the other hypertension drugs reduce that risk by an average of 38 percent. Conversely, beta-blockers are powerfully beneficial for patients who have suffered heart attacks, substantially reducing the chances that they will soon die. Beta-blockers also may work well for patients whose high blood pressure is not controlled by the other medications. Patients should not stop taking blood pressure drugs without first talking to their doctor. "We have the luxury now of a lot of drugs, and we can use the different ones for different situations," said Dr. Aram V. Chobanian, former dean of the Boston University School of Medicine. "The more we find out about these individual drugs, the more we will know about what specific patient populations they should be used in." J Am Coll Cardiol, 2007; 50:563-572, doi:10.1016/j.jacc.2007.04.060 (Published online 29 July 2007). Cardiovascular Protection Using Beta-Blockers A Critical Review of the Evidence Sripal Bangalore, MD, MHA*, Franz H. Messerli, MD*,1,*, John B. Kostis, MD,2 and Carl J. Pepine, MD,3 * St. Luke's-Roosevelt Hospital and Columbia University, New York, New York University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey University of Florida College of Medicine, Gainesville, Florida. Manuscript received February 14, 2007; revised manuscript received April 13, 2007, accepted April 30, 2007. * Reprint requests and correspondence: Dr. Franz H. Messerli, Director, Hypertension Program, Division of Cardiology, St. Luke's- Roosevelt Hospital, Columbia University College of Physicians and Surgeons, 1000 10th Avenue, Suite 3B-30, New York, New York 10019. (Email: fmesserl@chpnet.org). For more than 3 decades, beta-blockers have been widely used in the treatment of hypertension and are still recommended as first-line agents by national and international guidelines. Recent meta-analyses indicate that, in patients with uncomplicated hypertension, compared with other antihypertensive agents, first-line therapy with beta- blockers was associated with an increased risk of stroke, especially in the elderly cohort with no benefit for the end points of all-cause mortality, cardiovascular morbidity, and mortality. In this review, we critically analyze the evidence supporting the use of beta-blockers in patients with hypertension and evaluate evidence for its role in other indications. The review of the currently available literature shows that in patients with uncomplicated hypertension, there is a paucity of data or absence of evidence to support use of beta-blockers as monotherapy or as first-line agents. Given the increased risk of stroke, their "pseudo-antihypertensive" efficacy (failure to lower central aortic pressure), lack of effect on regression of target end organ effects like left ventricular hypertrophy and endothelial dysfunction, and numerous adverse effects, the risk benefit ratio for beta-blockers is not acceptable for this indication. However, beta- blockers remain very efficacious agents for the treatment of heart failure, certain types of arrhythmia, hypertropic obstructive cardiomyopathy, and in patients with prior myocardial infarction. Marilyn David and Vince, is this relevant to your discussion on atenolol? I know almost nothing about blood pressure medication, so I can't add anything to the discussion. Marilyn > David and Vince, is this relevant to your discussion on atenolol? I > know almost nothing about blood pressure medication, so I can't add > anything to the discussion. > > Marilyn Actually part of the story pretty accurately descibes my position "We in medicine like to say that we practice evidence-based medicine," said Dr. Franz H. Messerli, an author of the study and a cardiologist at St. Luke's-Roosevelt Hospital in New York. "What's the evidence here" for continued use of beta-blockers to treat hypertension, Messerli asked. "Zero. To my way of thinking, this is pretty alarming." I think it might be a little less than zero. Specifically for Atenolol. I believe Dr. Rind has a different view. Thanks Vince >>David and Vince, is this relevant to your discussion on atenolol? I >>know almost nothing about blood pressure medication, so I can't add [quoted text clipped - 16 lines] > > Thanks Vince I think for at least several years we've had evidence that beta blockers are not a good first choice for hypertension, since they do not seem to reduce mortality as much as other treatments. The article in JACC was just another analysis making the same point. That is quite different from saying there is evidence that treatment with beta blockers *increases* mortality.  SignatureDavid Rind drind@caregroup.harvard.edu It is interesting that they say beta blockers benefit people with heart failure or prior MI. My mother-in-law has heart failure and both my in-laws have had MIs, but both are on diuretics. Perhaps they are also on a beta blocker -- I will have to check. Marilyn > >>David and Vince, is this relevant to your discussion on atenolol? I > >>know almost nothing about blood pressure medication, so I can't add [quoted text clipped - 26 lines] > > -- As a never said beta blockers and only referred to atenolol as increase mortality I do not quite understand that comment. Atenolol on the other hand does tend toward an increase in mortality in some analysis. Some of the newer beta blockers may have better profiles. Atenolol however tends to cause diabetes and trends toward increase mortality when compared to placebo. That is quite different than saying atenolol decreases 'mortality'. The fact is that beta blocker have different risk and benefits. Atenolol has the most risk and least benefit. And until recently was widely given for hypertension. Two years ago the UK rewrote their guidelines to remove class on drugs as first line drugs in the treatment of hypertension. Sooner or later the guideline groups here will do the same. Thanks Vince bigvince <Vince.Miraglia@gmail.com> wrote in part: >As a never said beta blockers and only referred to atenolol as >increase mortality I do not quite understand that comment. Atenolol on [quoted text clipped - 5 lines] >have different risk and benefits. Atenolol has the most risk and least >benefit. Has atenolol been tested against other beta blockers? I've taken atenolol since 1989. I had a mitral valve repair in late 1988. Afterwards I had a mild sinus tachycardia which my cardiologist had no explanation for. I was put on atenolol 50 mg/d to address the tachycardia, My blood pressure was slightly elevated, so that was a secondary reason. As years went by, my bp rose a bit and, after trying captopril and getting a cough, i was put on an ARB (now Benicar). Fairly recently, I told my internist I wanted to see what would happen if I went off the atenolol. He increased the ARB dosage and had me drop to 25 mg/day atenolol. There was essentially no rise in heart rate after the first week. I have since reduced the atenolol to 12.5 mg/d and found no change in my heart rate (around 60 resting). My exercise tolerance is excellent. My internist feels that there may be benefit to staying on the low dose of atenolol, both because of my heart surgery history and because there is some evidence that it reduces the risk of atherosclerosis. I haven't decided yet whether to ditch the atenolol entirely. My bp is fine. -- Jim Chinnis Warrenton, Virginia, USA > bigvince <Vince.Miraglia@gmail.com> wrote in part: > [quoted text clipped - 31 lines] > -- > Jim Chinnis Warrenton, Virginia, USA Yabbut, it raises bg and insulin resistance. Susan , Virginia, USA> Yabbut, it raises bg and insulin resistance. And apparently lowers HDL Int Heart J. 2006 May;47(3):421-30. Links The effect of carvedilol on metabolic parameters in patients with metabolic syndrome.Uzunlulu M, Oguz A, Yorulmaz E. Department of Internal Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey. The objective of the present study was to explore the effect of carvedilol treatment on metabolic parameters in patients with metabolic syndrome. A total of 77 patients > or = 20 years of age (59 females, 18 males, mean age, 52.3 +/- 10.3) with stage 1 hypertension who fulfilled at least 3 of the metabolic syndrome criteria proposed by NCEP-ATP III were included in this prospective, randomized, controlled study. Patients were randomly assigned to receive daily treatment with carvedilol (n = 27, 12.5 mg/day orally for the first 2 days and 25 mg/day thereafter), atenolol (n = 26, 50 mg/day orally), or doxazosin (n = 24, 2 mg/day orally) for 90 days. Doses were doubled at the end of the 3rd week in patients whose blood pressure was inadequately controlled and amlodipine 10 mg was added to the treatment if the target blood pressure was still not reached at the end of week 6. The biochemical parameters and insulin sensitivity based on the HOMA-IR model were evaluated at baseline and at the end of treatment. Similar reductions in systolic and diastolic blood pressure were observed in all groups (P > 0.05). A significant decrease in HDL cholesterol levels occurred in the doxazosin and atenolol groups compared to the carvedilol group (percent change: -5.6 +/- 13.5 and -8 +/- 9.8 versus -0.1 +/- 12.2, respectively; P < 0.05) and a significant increase in apolipoprotein A1 level was observed in the carvedilol group compared to the doxazosin and atenolol groups (percent change: + 4.3 +/- 9.6 versus - 0.5 +/- 10.6 and -2.3 +/- 6.6, respectively; P < 0.05). There were no significant differences among the groups with respect to other parameters. It is concluded antihypertensive treatment with carvedilol in patients with metabolic syndrome effectively reduces blood pressure without adversely affecting metabolic parameters. PMID: 16823248 [PubMed - indexed fo Thanks Vince bigvince <Vince.Miraglia@gmail.com> wrote in part: >And apparently lowers HDL "percent change: -5.6 +/- 13.5" Nothing to write home about. My HDL usually runs around 70, anyway. Latest lipids: TC 163, LDL 85, TG 85, HDL 61, VLDL 17. I would have thought that there might be some atherosclerosis benefits from beta blockers due to the effects on the sympathetic nervous system. I think beta blockers may also reduce adverse changes in the heart muscle after heart failure (my case secondary to mitral valve failure) or infarct. No time to dig right now. -- Jim Chinnis Warrenton, Virginia, USA > bigvince <Vince.Miraglia@gmail.com> wrote in part: > [quoted text clipped - 6 lines] > > TC 163, LDL 85, TG 85, HDL 61, VLDL 17. These are the "worsened" results of reducing your statin dose? > I would have thought that there might be some atherosclerosis benefits from > beta blockers due to the effects on the sympathetic nervous system. I think > beta blockers may also reduce adverse changes in the heart muscle after > heart failure (my case secondary to mitral valve failure) or infarct. No > time to dig right now. But you have to balance that against the hypercortisolism they may induce, too, which promotes bg elevations, fat deposition and CVD. Susan Susan <nevermind@nomail.com> wrote in part: >x-no-archive: yes > [quoted text clipped - 10 lines] > >These are the "worsened" results of reducing your statin dose? I think you meant my atenolol dose? Yes, that's a lower HDL than usual, and it came after halving my atenolol. FWIW (not much). >> I would have thought that there might be some atherosclerosis benefits from >> beta blockers due to the effects on the sympathetic nervous system. I think [quoted text clipped - 4 lines] >But you have to balance that against the hypercortisolism they may >induce, too, which promotes bg elevations, fat deposition and CVD. Well, this is why we need prospective, randomized trials with hard endpoints. We can be armchair philosophers about this complex biological stuff and seem to make sense while staking claim to almost any view whatsoever. -- Jim Chinnis Warrenton, Virginia, USA > I think you meant my atenolol dose? Yes, that's a lower HDL than usual, and > it came after halving my atenolol. FWIW (not much). My bad. I'm not sure it's noteworthy; mine also bounces routinely from a low of 58 up to 70. > Well, this is why we need prospective, randomized trials with hard > endpoints. We can be armchair philosophers about this complex biological > stuff and seem to make sense while staking claim to almost any view > whatsoever. Some of us can't afford to wait for someone else to do the work. Susan Susan <nevermind@nomail.com> wrote in part: >x-no-archive: yes > [quoted text clipped - 10 lines] > >Some of us can't afford to wait for someone else to do the work. That's true. We have to figure out how we think things work based on what we know now. Unfortunately, that usually leaves us with huge uncertainties that make all that thinking less useful than one might expect. -- Jim Chinnis Warrenton, Virginia, USA > Unfortunately, that usually leaves us with huge uncertainties that make all > that thinking less useful than one might expect. > -- I think opting against taking stuff with myriad unknown effects that your doctor will NEVER observe nor figure out is safest. Susan > > I think you meant my atenolol dose? Yes, that's a lower HDL than usual, and > > it came after halving my atenolol. FWIW (not much). [quoted text clipped - 8 lines] > > Some of us can't afford to wait for someone else to do the work. Sadly, you remind me of the "jack-rabbit" motorist who gets stopped at every traffic light and consequently uses up twice as much gasoline. Be hungry... be healthy... be blessed: http://TheWellnessFoundation.com/press.asp Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist It seems to me I heard somewhere that Jim Chinnis wrote in article <f7qjb314kfp2anugdpuedg0c67hfs2hcfv@4ax.com>: >Has atenolol been tested against other beta blockers? >I've taken atenolol since 1989. I had a mitral valve repair in late 1988. >Afterwards I had a mild sinus tachycardia which my cardiologist had no >explanation for. I was put on atenolol 50 mg/d to address the tachycardia, >My blood pressure was slightly elevated, so that was a secondary reason. >As years went by, my bp rose a bit and, after trying captopril and getting a >cough, i was put on an ARB (now Benicar). >Fairly recently, I told my internist I wanted to see what would happen if I >went off the atenolol. He increased the ARB dosage and had me drop to 25 >mg/day atenolol. There was essentially no rise in heart rate after the first >week. I have since reduced the atenolol to 12.5 mg/d and found no change in >my heart rate (around 60 resting). My exercise tolerance is excellent. >My internist feels that there may be benefit to staying on the low dose of >atenolol, both because of my heart surgery history and because there is some >evidence that it reduces the risk of atherosclerosis. >I haven't decided yet whether to ditch the atenolol entirely. My bp is fine. My atenolol experience is similar to Jim's. I've been on it since a mild MI in 1998, most of that time at 12.5mg/day. Even at that level it interfered with my running, but I switched to taking it after my morning run and haven't had any overt problems since. I'd really like to get off it entirely, especially since my files have several notes about bradycardia, so IMO it doesn't really make sense to take atenolol to reduce my heart rate, which at rest is around 35/40bpm, but that's the reason my cardiologists have routinely given. Blood pressure is normal thanks mostly to running, maybe partly to lisinopril 20mg/day. I come from a strong family history of cardiovascular sufferers with early deaths and chronic heart problems. SignatureDon Kirkman >Doctors urged to curb reliance on beta-blockers >Research favors other drugs to control hypertension [quoted text clipped - 180 lines] > >Marilyn Two sides to the story! Beta blockers may slow CAD progression, say IVUS data July 6, 2007 Steve Stiles Cleveland, OH - Beta blockers can slow the progression of coronary atherosclerosis, according to a pooled analysis of randomized trials that used intravascular ultrasound (IVUS) imaging to measure changes in vascular-disease severity over time [1]. The study was published in the July 3, 2007 issue of the Annals of Internal Medicine. The finding, which appeared to be independent of lipid-modifying drug therapies, supports the long-term use of beta blockers in the broad population of patients with coronary artery disease, conclude the authors, led by Dr Ilke Sipahi (Cleveland Clinic Foundation, OH). "Unless there is severe intolerance or clear-cut contraindications in patients with coronary disease, regardless of their presentationstenting, acute MI, unstable or stable angina, silent ischemia, asymptomatic coronary diseaseit appears that all of these patients should be on beta blockers," Sipahi told heartwire. > >Doctors urged to curb reliance on beta-blockers > >Research favors other drugs to control hypertension [quoted text clipped - 4 lines] > >published studies and found that other hypertension pills work better > >and cause fewer side effects. <snip> > Two sides to the story! > [quoted text clipped - 18 lines] > ischemia, asymptomatic coronary disease-it appears that all of these > patients should be on beta blockers," Sipahi told heartwire. Medicine remains an art. Be hungry... be healthy... be blessed: http://TheWellnessFoundation.com/press.asp Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist The American Journal of Cardiology Article in Press, Uncorrected Proof - A Meta-Analysis of 94,492 Patients With Hypertension Treated With - Blockers to Determine the Risk of New Onset Diabetes Mellitus Sripal Bangalore MD, MHAa, , , Sanobar Parkar MD, MPHa, Ehud Grossman MDb and Franz H. Messerli MDa aDepartment of Medicine, Division of Cardiology, St. Luke's-Roosevelt Hospital and Columbia University College of Physicians and Surgeons, New York, New York bChaim Sheba Medical Center and Sackler School of Medicine, Tel- Hashomer, Israel Beta blockers used for the treatment of hypertension may be associated with increased risk for new-onset diabetes mellitus (DM). A search of Medline, PubMed, and EMBASE was conducted for randomized controlled trials of patients taking blockers as first-line therapy for hypertension with data on new-onset DM and follow-up for 1 year. Twelve studies evaluating 94,492 patients fulfilled the inclusion criteria. Beta-blocker therapy resulted in a 22% increased risk for new-onset DM (relative risk 1.22, 95% confidence interval [CI] 1.12 to 1.33) compared with nondiuretic antihypertensive agents. A higher baseline fasting glucose level (odds ratio [OR] 1.01, 95% CI 1.00 to 1.02, p = 0.004) and greater systolic (OR 1.05, 95% CI 1.05 to 1.08, p = 0.001) and diastolic (OR 1.06, 95% CI 1.01 to 1.10, p = 0.011) blood pressure differences between the 2 treatment modalities were significant univariate predictors of new-onset DM. Multivariate meta- regression analysis showed that a higher baseline body mass index (OR 1.17, 95% CI 1.01 to 1.33, p = 0.034) was a significant predictor of new-onset DM. The risk for DM was greater with atenolol, in the elderly, and in studies in which blockers were less efficacious antihypertensive agents and increased exponentially with increased duration on blockers. For the secondary end points, blockers resulted in a 15% increased risk for stroke, with no benefit for the end point of death or myocardial infarction. In conclusion, blockers are associated with an increased risk for new-onset DM, with no benefit for the end point of death or myocardial infarction and with a 15% increased risk for stroke compared with other agents. This risk was greater in patients with higher baseline body mass indexes and higher baseline fasting glucose levels and in studies in which blockers were less efficacious antihypertensive agents compared with other treatments. Corresponding author: Tel: 212-523-5678; fax: 212-957-3680. MarilynMann <mannm@comcast.net> wrote in part: >"Beta-blocker therapy resulted in a 22% increased risk for >new-onset DM (relative risk 1.22, 95% confidence interval [CI] 1.12 to >1.33) compared with nondiuretic antihypertensive agents. ... >The risk for DM was greater with atenolol... >and increased exponentially with increased >duration on blockers." Ouch. -- Jim Chinnis Warrenton, Virginia, USA > MarilynMann <mannm@comcast.net> wrote in part: > [quoted text clipped - 6 lines] > > Ouch. This increase likely would be erased when compared with thiazide diuretics, which are first line for treating hypertension and are known to exacerbate insulin resistance. Moreover, suspect that the increase would be less dramatic when compared to medications other than ACE inhibitors and ARBs which are known insulin sensitizers. Ime, the risk of type-2 diabetes in folks on beta-blockers track the accumulation of VAT. Those who avoid overeating (eating until stomach is stretched killing their hunger) lose all the VAT that is necessary for the insulin resistance (IR/MetS) that is a pre-requisite for developing type-2 diabetes. Be hungry... be healthy... be happy... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist "Andrew B. Chung, MD/PhD" <heartdoc22@emorycardiology.com> wrote in part: >> MarilynMann <mannm@comcast.net> wrote in part: >> [quoted text clipped - 12 lines] >increase would be less dramatic when compared to medications other >than ACE inhibitors and ARBs which are known insulin sensitizers. Yes. Thanks for the observation. There is also a possibility that because central blood pressure is higher with first line treatment by a beta blocker like atenolol, that might increase the risk for DM via some sort of interaction with endothelial function or other things I can't imagine. >Ime, the risk of type-2 diabetes in folks on beta-blockers track the >accumulation of VAT. This was a meta-analysisis, and there's only a draft abstract, so it's hard to read too much into the details, but it looks like BMI (only a fair-to-poor surrogate for VAT) had an interaction effect with blocker treatment, meaning that treatment had an effect distinct from effect on BMI. It's possible the BMI they refer to was the BMI at baseline, though. >Those who avoid overeating (eating until stomach is stretched killing >their hunger) lose all the VAT that is necessary for the insulin >resistance (IR/MetS) that is a pre-requisite for developing type-2 >diabetes. I hope that is the case, as I am well on the way to having the waist of a supermodel... And 19 years on atenolol 50 mg, first with a thiazide diuretic, and later with an ARB instead. The atenolol was for mild sinus tachycardia following an otherwise very successful mitral valve repair--not primary treatment for hypertension. I'm ready to quit the atenolol entirely after a word with my internist. We reduced it to 25 mg about a year ago. My BP runs about 106/65 now. I doubt my pulse will rise much from dropping the 25 mg atenolol, and if it does, I think one of the newer vasodilating betablockers would be a better choice. -- Jim Chinnis Warrenton, Virginia, USA > Andrew, in the Holy Spirit, boldly wrote: > >> friend MarilynMann <mannm@comcast.net> wrote in part: [quoted text clipped - 15 lines] > > Yes. Thanks for the observation. Thanks be to GOD :-) > There is also a possibility that because central blood pressure is higher > with first line treatment by a beta blocker like atenolol, that might > increase the risk for DM via some sort of interaction with endothelial > function or other things I can't imagine. Atenolol not doing as well at reducing sympathetic tone would make it more likely to exacerbate insulin resistance. > >Ime, the risk of type-2 diabetes in folks on beta-blockers track the > >accumulation of VAT. [quoted text clipped - 4 lines] > treatment, meaning that treatment had an effect distinct from effect on BMI. > It's possible the BMI they refer to was the BMI at baseline, though. The latter is correct. Moreover, BMI is a poor surrogate for VAT. Ime, WHR is a better indicator of VAT. > >Those who avoid overeating (eating until stomach is stretched killing > >their hunger) lose all the VAT that is necessary for the insulin [quoted text clipped - 3 lines] > I hope that is the case, as I am well on the way to having the waist of a > supermodel... Hopefully you have an appetite to match the famed appetites of healthy supermodels :-) > And 19 years on atenolol 50 mg, first with a thiazide > diuretic, and later with an ARB instead. The atenolol was for mild sinus [quoted text clipped - 5 lines] > my pulse will rise much from dropping the 25 mg atenolol, and if it does, I > think one of the newer vasodilating betablockers would be a better choice. The latter would be wise if beta blockade is needed. May GOD bless you in HIS mighty way making you healthier (hungrier) than ever: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist "Andrew B. Chung, MD/PhD" <heartdoc22@emorycardiology.com> wrote in part: >> Andrew, in the Holy Spirit, boldly wrote: >> >> friend MarilynMann <mannm@comcast.net> wrote in part: [quoted text clipped - 25 lines] >Atenolol not doing as well at reducing sympathetic tone would make it >more likely to exacerbate insulin resistance. Why is that? I will research it. Thank you. >> >Ime, the risk of type-2 diabetes in folks on beta-blockers track the >> >accumulation of VAT. [quoted text clipped - 7 lines] >The latter is correct. Moreover, BMI is a poor surrogate for VAT. >Ime, WHR is a better indicator of VAT. Yes. That's very clear now. BMI never made much sense, anyway... >> >Those who avoid overeating (eating until stomach is stretched killing >> >their hunger) lose all the VAT that is necessary for the insulin [quoted text clipped - 6 lines] >Hopefully you have an appetite to match the famed appetites of healthy >supermodels :-) I have a healthy appetite, but I'm able to continue losing the little excess weight I have, for the sake of science. >> And 19 years on atenolol 50 mg, first with a thiazide >> diuretic, and later with an ARB instead. The atenolol was for mild sinus [quoted text clipped - 7 lines] > >The latter would be wise if beta blockade is needed. I doubt that it will. But if so, I'll discuss it with my doctor after a bit of reading. -- Jim Chinnis Warrenton, Virginia, USA Jim Chinnis <jchinnis@SPAMalum.mit.edu> wrote in part: >>> I'm ready to quit the atenolol entirely after a word with my internist. We >>> reduced it to 25 mg about a year ago. My BP runs about 106/65 now. I doubt [quoted text clipped - 5 lines] >I doubt that it will. But if so, I'll discuss it with my doctor after a bit >of reading. I am off atenolol... -- Jim Chinnis Warrenton, Virginia, USA > friend Jim Chinnis <jchinnis@SPAMalum.mit.edu> wrote in part: > [quoted text clipped - 9 lines] > > I am off atenolol... Glad to read this. Such are the benefits of losing the bad "inside" fat (visceral adipose tissue or VAT). Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist "Andrew B. Chung, MD/PhD" <heartdoc17@emorycardiology.com> wrote in part: >> friend Jim Chinnis <jchinnis@SPAMalum.mit.edu> wrote in part: >> [quoted text clipped - 9 lines] >> >> I am off atenolol... >Such are the benefits of losing the bad "inside" fat (visceral adipose >tissue or VAT). I am tracking my waist-to-hip ratio. Now at about 0.88, maybe 0.87. -- Jim Chinnis Warrenton, Virginia, USA > Andrew, in the Holy Spirit, boldly wrote: > >> friend Jim Chinnis <jchinnis@SPAMalum.mit.edu> wrote in part: [quoted text clipped - 15 lines] > > I am tracking my waist-to-hip ratio. Now at about 0.88, maybe 0.87. Because of your history, your goal should be less than 0.85 with lower being better with no such thing as too low. Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist > I am off atenolol... > -- Great. That's one attack on your adrenals removed. Now to lose the statin. Susan Susan <nevermind@nomail.com> wrote in part: >x-no-archive: yes > [quoted text clipped - 4 lines] > >Now to lose the statin. I'm working on it. -- Jim Chinnis Warrenton, Virginia, USA > Susan <nevermind@nomail.com> wrote in part: > [quoted text clipped - 10 lines] > -- > Jim Chinnis Warrenton, Virginia, USA YES! Best news I've heard in a LONG time! Susan > >>>I am off atenolol... > >> [quoted text clipped - 5 lines] > > YES! Best news I've heard in a LONG time! Reading that someone is losing the VAT by eating less, down to the optimal amount is indeed good news :-) It is likely that Jim will no longer need lipid-lowering medications when his WHR falls below 0.85 (0.75 in women) indicating the VAT is gone. Truly, it is only when we are hungry that our bodies get rid of the VAT. Hunger is wonderful :-) Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist > Jim Chinnis <jchin...@SPAMalum.mit.edu> wrote in part: > [quoted text clipped - 11 lines] > -- > Jim Chinnis Warrenton, Virginia, USA Thats good news . Very little upside for a chance of many side effects. Have you noticed a difference in your energy levels. Thanks Vince > Thats good news . Very little upside for a chance of many side > effects. Have you noticed a difference in your energy levels. You don't really expect Jim to notice that after withdrawing a low dose so recently? I mean, it could happen, but the endocrine feedback loop takes about 3 months to complete readjustments. Susan Susan <nevermind@nomail.com> wrote in part: >x-no-archive: yes > [quoted text clipped - 6 lines] > >Susan And I'll be three months older then, too. ;-) -- Jim Chinnis Warrenton, Virginia, USA bigvince <Vince.Miraglia@gmail.com> wrote in part: >> Jim Chinnis <jchin...@SPAMalum.mit.edu> wrote in part: >> [quoted text clipped - 14 lines] >Thats good news . Very little upside for a chance of many side >effects. Have you noticed a difference in your energy levels. I'm dropping it with my doctor's blessing but over a four week period. I'm to take half a dose (12.5 mg) for a while and then nothing. I dropped from 50 mg to 25 mg a while back and didn't notice much change other than some increased variability in heart rate. Resting pulse slowly came down close to the level before the drop in dose. So I don't know what effect dropping the 25 mg will have yet but I expect it will be positive. (Last night, while still on 25 mg, my bp was 94/58--the lowest I've ever seen and a bit scary, but I've lost weight and kept exercise levels higher lately. My pulse was 60. My white-coat BP reading taken by my internist yesterday afternoon was 122/74). -- Jim Chinnis Warrenton, Virginia, USA > bigvince <Vince.Miraglia@gmail.com> wrote in part: > [quoted text clipped - 30 lines] > lately. My pulse was 60. My white-coat BP reading taken by my internist > yesterday afternoon was 122/74). (You probably mean "while still on 12.5 mg") Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoudation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist "Andrew B. Chung, MD/PhD" <heartdoc11@emorycardiology.com> wrote in part: >> bigvince <Vince.Miraglia@gmail.com> wrote in part: >> [quoted text clipped - 32 lines] > >(You probably mean "while still on 12.5 mg") No, I took 25 mg yesterday afternoon at 3pm, when I always take it. (That's usually after my stint at the gym.) I'll take my first 12.5 mg dose today at 3pm. -- Jim Chinnis Warrenton, Virginia, USA > Andrew, in the Holy Spirit, boldly wrote: > >> bigvince <Vince.Miraglia@gmail.com> wrote in part: [quoted text clipped - 37 lines] > usually after my stint at the gym.) I'll take my first 12.5 mg dose today at > 3pm. Sorry about misunderstanding what you meant earlier when you posted that you were now off of the atenolol. Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist > Jim Chinnis Warrenton, Virginia, USA "Andrew B. Chung, MD/PhD" <heartdoc11@emorycardiology.com> wrote in part: >Sorry about misunderstanding what you meant earlier when you posted >that you were now off of the atenolol. I am following a taper until I am off. The "off" decision has been made, and that's what I meant by being off. A bit confusing, I know. If I need to reduce sympathetic tone after a month or more, we'll try it with something other than atenolol. Thanks to you, to vince, to Marilyn, to Susan, and to others for the helpful discussions here re beta blockers. -- Jim Chinnis Warrenton, Virginia, USA > Andrew, in the Holy Spirit, boldly wrote: > [quoted text clipped - 9 lines] > Thanks to you, to vince, to Marilyn, to Susan, and to others for the helpful > discussions here re beta blockers. You are welcome, Jim :-) Redirecting all thanks and praises to GOD for HIS knowledge and wisdom concerning VAT and how pathological it is, so that we will both be that much more blessed (hungrier). Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist > "Andrew B. Chung, MD/PhD" <heartdo...@emorycardiology.com> wrote in part: > [quoted text clipped - 14 lines] > >increase would be less dramatic when compared to medications other > >than ACE inhibitors and ARBs which are known insulin sensitizers. The strongest increase in diabetes is with atenolol which increases IR and tends to make people to tired to aggressively exercise. Some newer beta blockers are metabolic neutral. thiazide diuretics also increase IR but to a lesser degree.Arbs and ACE inhibitors decrease IR but like Advandia have been linked at least in some studys to an increase in MIs. The other groups do however offer reduction as opposed to placebo in strokes and other events atenolol does not. Considering the fact that atenolol is a vasoconsticting beta blocker that has more side effects less benefit then any other blood pressure treatment a far question is when used for hypertension does this drug total less than zero . I suspect it does . This year 50 million people will receive this drug mostly for hypertension sometimes for example those with insulin resistance syndrome where it worsens both the IR and the hdl levels . A question for Dr. Chung does the poor perfomance of atenolol IE other beta blocker carry over to those with heart disease Thanks Vince The Consultant Dermatologist I saw yesterday about the exfoliative dermatitis which removed all of the skin from both of my hands is 99% certain that it was caused by the 25mg Hydrochlorothiazide I was taking for hypertension. Apparently thiazides are heavily implicated in this kind of adverse reaction. >> MarilynMann <mannm@comcast.net> wrote in part: >> [quoted text clipped - 28 lines] > >Andrew <>< > The Consultant Dermatologist I saw yesterday about the exfoliative > dermatitis which removed all of the skin from both of my hands is 99% > certain that it was caused by the 25mg Hydrochlorothiazide I was > taking for hypertension. Apparently thiazides are heavily implicated > in this kind of adverse reaction. what have they put you on for the hypertension. How are you tolerating it. Thanks Vince >> The Consultant Dermatologist I saw yesterday about the exfoliative >> dermatitis which removed all of the skin from both of my hands is 99% [quoted text clipped - 6 lines] > > Thanks Vince Not taking anything at the moment. It's been 3 weeks off everything now, apart for my Metformin for Type 2 Diabetes. I'm getting BP readings in the 150/85 range at present which I'm not really panicking about. I'll go back to them when my skin has completely cleared up (which it is doing now) and insist on different medication, carefully and one at a time. I don't want that lot again - not a pleasant experience. Apparently the exfoliative dermatitis is not all that common, but 40% of cases are diagnosed as due to a drug reaction with thiazides as the main culprit. |
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