Exercise testing and training with β-adrenergic blockade: Role of the drug washout period in “unmasking” a training effect

Sweeney, Mary Ellen; Fletcher, Barbara J.; Fletcher, Gerald F.

doi:10.1016/0002-8703(89)90228-7

Cited by 25 publications

(9 citation statements)

References 25 publications

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“…Higher cardiac output after training is achieved solely by an increase in stroke volume, because maximal heart rate is not usually increased after training in normal individuals. 125 On the basis of data in healthy subjects, 126 a training effect can be achieved in a subject in the presence of selective or nonselective ␤-adrenergic blockade. However, such changes may be attenuated 127 and/or may not be detected by metabolic exercise studies until after the drug is withdrawn.…”

Section: Maximal Oxygen Uptakementioning

confidence: 99%

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Exercise Standards for Testing and Training

Fletcher¹,

Balady²,

Amsterdam³

et al. 2001

Circulation

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1,674

724

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Section: Maximal Oxygen Uptakementioning

confidence: 99%

“…However, such changes may be attenuated 127 and/or may not be detected by metabolic exercise studies until after the drug is withdrawn. 126 …”

Section: Maximal Oxygen Uptakementioning

confidence: 99%

Exercise Standards for Testing and Training

Fletcher¹,

Balady²,

Amsterdam³

et al. 2001

Circulation

Self Cite

1,674

724

View full text Add to dashboard Cite

“…In order to correctly evaluate a drug's protective potential, eligible patients should ideally then enter a washout/placebo run-in period, which could also be flexible according to BP levels and the patients' prior antihypertensive treatment [Sweeney et al 1989]. In our group, when referring patient's to such procedures for an assessment, that most likely is of little interest for the patient and more for the scientific community, use of a home BP monitoring device, with or without telemonitoring capabilities is recommended, in order to ensure safe withdrawal from previous antihypertensive treatments and also bring to notice any untoward rise in BP (≥180/110 mmHg) during the study period [Fletcher et al 2001].…”

Section: Exercise Testing As a Tool For Drug Development In Hypertensionmentioning

confidence: 99%

Exercise testing in hypertensive patients for assessing the cardiovascular protective potential of antihypertensive drugs

Brunel

Baschiera

Cífková

2013

Therapeutic Advances in Cardiovascular Disease

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Exercise testing is an established noninvasive tool in cardiology used to diagnose and guide treatment in individuals with suspected or confirmed coronary artery disease. Owing to the wealth of information it provides, exercise testing is also being utilized to evaluate prehypertensive stages, characterize hypertension, assess tolerance to exercise and the efficacy of antihypertensive therapies, and predict target organ damage and cardiovascular risk. The literature on exercise tolerance tests is relatively limited since these studies are difficult to conduct although they represent a valuable test for evaluating the benefits of antihypertensive therapies beyond their blood-pressure-lowering efficacy at rest or during exercise. Such a setting can be immensely useful for the evaluation and for the differentiation of treatments, especially in patients with evident rises in systolic blood pressure and with concomitant diseases, who are at higher risk of stroke. Exercise-induced increase in systolic blood pressure from rest to peak exercise should therefore be used as the primary efficacy variable. There is growing evidence that central pressure is a better predictor for cardiovascular risk than peripheral blood pressure, since this variable takes into account the overall effect of vascular aging and increased arterial stiffness that age and other concomitant diseases may induce. It is also important to include central aortic blood pressure and biomarkers of hypertension and cardiac disease in the overall assessment.

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“…Whereas some studies have reported statistically significant improvements in total exercise duration with beta blockade, others have not [42]. Long-term beta blockade can attenuate maximum oxygen consumption [43], and, consequently, maximal exercise tolerance testing may not be the appropriate method for assessing an improvement in functional capacity. In a randomized trial of the effects of the vasodilating beta blocker, nebivolol, submaximal exercise time, assessed by the distance traversed during a 6-minute walk test, was increased in the beta blocker-treated group compared with the placebo group [44].…”

Section: Effects Of Beta Blockade On Exercise Tolerance In Heart Failurementioning

confidence: 99%

Symptomatic systolic ventricular failure

Sharpe

1999

Curr Cardiol Rep

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Over the past 20 to 30 years there have been significant advances in the management of heart failure related to improved understanding of pathophysiology, better methods of assessment, and improved drug treatments. The aims of treatment have broadened, with increased emphasis on earlier intervention. Clinical research activity in this area has been considerable, increasingly allowing an evidence-based approach to management. Most earlier trials of treatment were relatively short-term, small-group studies with various clinical end points, including severity of symptoms, exercise performance, and left ventricular function assessment; however, increasingly a higher standard of evidence has been required, including a provision of reliable, large-scale mortality trial data. This has been further encouraged, if not mandated, by the relatively recent appreciation that some agents may demonstrate dissociation of treatment effects, possibly dose related, with improved short-term outcomes but adverse effects on survival with prolonged treatment. The general principles of management of congestive heart failure encompass patient evaluation and confirmation of the diagnosis, consideration, and correction of underlying remediable causes and precipitating factors, pharmacological treatment, patient education and counseling, and planned follow-up, as summarized in recently published guidelines. This review focuses primarily on the available randomized controlled clinical trial evidence related to the pharmacological treatment of the clinical congestive heart failure syndrome. Other aspects of management, such as patient education, counseling, and planned follow-up, should be regarded as complementary to pharmacological treatment and important to ensure compliance and optimal long-term outcomes.

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Exercise testing and training with β-adrenergic blockade: Role of the drug washout period in “unmasking” a training effect

Cited by 25 publications

References 25 publications

Exercise Standards for Testing and Training

Exercise Standards for Testing and Training

Exercise testing in hypertensive patients for assessing the cardiovascular protective potential of antihypertensive drugs

Symptomatic systolic ventricular failure

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