Selective or nonselective beta-adrenergic blockade in patients with congestive heart failure

Change in Systemic Medication and its Influence on Intraocular Pressure - Results From the Gutenberg Health Study

Purpose

The purpose of this study was to investigate the relationship between the change in systemic medication and intraocular pressure (IOP) on a population-based level.

Methods

The Gutenberg Health Study is a population-based prospective observational cohort study in Germany. As part of the baseline examination (2007-2012) and 5-year follow-up examination (2012-2017), IOP was measured by non-contact tonometry. Systemic medication was recorded at both time points. Multivariable regression analyses were carried out to analyze associations. Moreover, we calculated the dose-response relationship for the dosage change of selective beta-blockers with IOP change over 5 years.

Results

The analysis population included 19,161 eyes of 9633 participants. IOP change was lower in participants with new intake of selective beta-blockers (-0.31 mm Hg, P < 0.001) and increased in those with discontinuation of selective beta-blocker intake (+0.28 mm Hg, P = 0.02). Associations between IOP change and statins and calcium channel blockers (CCBs) could be attributed to co-medications. There was a dose-response relationship for change in selective beta-blocker intake and change in IOP (-0.16 mm Hg/100 mg, P = 0.02).

Conclusions

Use of systemic selective beta-blockers is associated with an IOP change on a population level, whereas the association with other systemic medications on IOP change could be explained by co-medication use or change in blood pressure. Patients undergoing IOP monitoring and management should routinely be asked about changes in systemic medications.

Chronic administration of carvedilol improves cardiac function in 6-month-old Syrian cardiomyopathic hamsters

Heart failure (HF) is a multifactorial and progressive disease that has been linked to activation of the renin-angiotensin and sympathetic systems. In recent years, beta-blockers have been shown to improve the status of HF patients, although the precise mechanisms remain unclear. The present study evaluates the effect of beta-blockade with carvedilol (1 mg/kg/day) on cardiovascular function in 2- and 6-month-old cardiomyopathic hamsters (SCH) after 1-month and 5-month treatment periods with the drug, respectively. Age-matched golden hamsters were used as controls (CT). Systolic blood pressure (SBP) and echocardiographic studies were evaluated. The latter studies included left ventricular end-systolic (LVESV) and end-diastolic (LVEDV) volumes, ejection fraction (EF), cardiac output index (COI), heart rate (HR), and left ventricular posterior wall thickness (LVPWT). In 2-month-old SCH, carvedilol administration during a 1-month period reduced SBP from 107.59 +/- 3.49 to 77.26 +/- 3.49 mm Hg (n = 5, p < 0.05). At this stage, cardiac parameters in SCH were similar to those of controls and were not affected by carvedilol administration. In 6-month-old SCH, 5-month administration of carvedilol decreased SBP from 102.16 +/- 3.61 to 90.60 +/- 2.80 mm Hg (n = 5, p < 0.05), HR from 363 +/- 14 to 324 +/- 14 bpm (n = 5, p < 0.05), and LVESV from 0.18 +/- 0.01 to 0.13 +/- 0.01 ml/100 g BW (n = 5, p < 0.05), and increased EF and COI by 14 and 23%, respectively (n = 5, p < 0.05). The drug did not modify LVEDV or LVPWT. These results reveal that carvedilol significantly improves cardiac function in 6-month-old cardiomyopathic hamsters, but it does not prevent ventricular dilatation. Improved cardiac function appears to be secondary to decreased total peripheral resistance, due mainly to the vasodilator properties of the drug. Thus, overactivation of the sympathetic system is not likely to be a determining factor in the etiology of dilated cardiomyopathy in this animal model.