A Comparison of Celiprolol and Chlorthalidone in Hypertensive Patients with Reversible Bronchial Obstruction

Dorow, P; Clauzel, A. M.; Capone, P.; Mayol, Renato; Mathieu, M.

doi:10.1097/00005344-198608004-00022

Cited by 18 publications

(8 citation statements)

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“…The available evidence has major limitations. Only two studies involved more than 20 patients,, two were single rather than double‐blinded,, and others lacked placebo controls ,,,. Not one study included patients with HF.…”

Section: Discussionmentioning

confidence: 99%

Bisoprolol in patients with heart failure and moderate to severe chronic obstructive pulmonary disease: a randomized controlled trial

Hawkins

MacDonald

Petrie

et al. 2009

European J of Heart Fail

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AimsHeart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently coexist. No study has prospectively examined the effects of beta-blockade in those with both conditions. Methods and resultsWe randomized 27 patients with HF and coexistent moderate or severe COPD to receive bisoprolol or placebo, titrated to maximum tolerated dose over 4 months. The primary outcome was forced expiratory volume in 1 s (FEV 1 ). The study is registered with ClinicalTrials.gov, number: NCT00702156. Patients were elderly and predominantly male. Cardiovascular comorbidity, smoking history, and pulmonary function were similar in each group (mean FEV 1 1.37 vs. 1.26 L, P ¼ 0.52). A reduction in FEV 1 occurred after 4 months following treatment with bisoprolol compared with placebo (270 vs. þ120 mL, P ¼ 0.01). Reversibility following inhaled b 2 -agonist and static lung volumes were not impaired by bisoprolol. All measures of health status exhibited a consistent non-significant improvement, including the Short Form 36 physical and mental component scores (2.6 vs. 0.5 and 0.8 vs. 20.3, respectively), Minnesota Living with Heart Failure Questionnaire (22.5 vs. 3.5) and Chronic Respiratory Questionnaire (0.07 vs. 20.24). The mean number of COPD exacerbations was similar in the bisoprolol and placebo groups (0.50 and 0.31, respectively, P ¼ 0.44). ConclusionInitiation of bisoprolol in patients with HF and concomitant moderate or severe COPD resulted in a reduction in FEV 1 . However, symptoms and quality of life were not impaired.--

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Section: Discussionmentioning

confidence: 99%

Bisoprolol in patients with heart failure and moderate to severe chronic obstructive pulmonary disease: a randomized controlled trial

Hawkins

MacDonald

Petrie

et al. 2009

European J of Heart Fail

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“…Medical subject heading (MeSH) terms "respiratory tract diseases" and "adrenergic beta-antagonists" yielded 227 studies, 18 of which addressed the review objectives (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Key word searches "chronic obstructive lung disease" and "beta adrenergic receptor blocking agent" or "[beta-blocker name]" identified 2 further studies (23,24).…”

Section: Methodsmentioning

confidence: 99%

“…A Cochrane library meta-analysis concluded that long-term cardioselective beta-blockade is safe and well-tolerated in COPD (25,62). This meta-analysis evaluated pulmonary function in 20 randomized, controlled, crossover trials of cardioselective beta 1 -blockers in patients with COPD (Table 2) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). No study included any patients with HF.…”

Section: Randomized Trials Of Cardioselective Beta-blockade In Copdmentioning

confidence: 99%

“…Only 2 studies involved more than 20 patients (15,23), some were only single-blinded (19,20), and others lacked placebo control (15,16,19,24). Eleven trials involved a single treatment dose, and only 1 lasted longer than a month (15). The effect of long-term beta-blockade, therefore, is unknown.…”

Section: Randomized Trials Of Cardioselective Beta-blockade In Copdmentioning

confidence: 99%

“…Of the 20 trials included in the Cochrane meta-analysis, 7 involved patients with reversible airflow obstruction, defined by FEV 1 improvement Ն15% following beta 2 -agonists (10,11,(13)(14)(15)19,20). Those studies show FEV 1 was unaffected by either single dose or longer duration cardioselective beta-blockade (-1.8% and -1.26%, respectively).…”

Section: Effect Of Cardioselective Beta-blockade In Copd With Reversimentioning

confidence: 99%

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Heart Failure and Chronic Obstructive Pulmonary Disease

Hawkins¹,

Petrie²,

MacDonald³

et al. 2011

Journal of the American College of Cardiology

127

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The combination of heart failure and chronic obstructive pulmonary disease presents many therapeutic challenges. The cornerstones of therapy are beta-blockers and beta-agonists, respectively. Their pharmacological effects are diametrically opposed, and each is purported to adversely affect the alternative condition. The tolerability of beta-blockade in patients with mild and fixed airflow obstruction likely extends to those with more severe disease. However, the evidence is rudimentary. The long-term influence of beta-blockade on pulmonary function, symptoms, and quality of life is unclear. Low-dose initiation and gradual up-titration of cardioselective beta-blockers is currently recommended. Robust clinical trials are needed to provide the answers that may finally allay physicians' mistrust of beta-blockers in patients with chronic obstructive pulmonary disease. Beta-agonists are associated with incident heart failure in patients with pulmonary disease and with increased mortality and hospitalization in those with existing heart failure. These purported adverse effects require further investigation. In the meantime, clinicians should consider carefully the etiology of dyspnea and obtain objective evidence of airflow obstruction before prescribing beta-agonists to patients with heart failure.

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