Multiparametric comparison of CARvedilol, vs. NEbivolol, vs. BIsoprolol in moderate heart failure: The CARNEBI trial

Contini, Mauro; Apostolo, Anna; Cattadori, Gaia; Paolillo, Stefania; Iorio, Annamaria; Bertella, Erika; Salvioni, Elisabetta; Alimento, Marina; Farina, Stefania; Palermo, Pietro; Loguercio, Monica; Mantegazza, Valentina; Karsten, Marlus; Sciomer, Susanna; Magrì, Damiano; Fiorentini, Cesare; Agostoni, Piergiuseppe

doi:10.1016/j.ijcard.2013.01.277

Cited by 69 publications

(69 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This did not translate into improved exercise capacity; however, it did not result in any adverse effect nor in a reduction of physical performance. This is at variance from other antihypertensive drugs suggested to be used at altitude, such as some beta blockers, that may have a negative impact on ventilatory control and exercise capacity in hypoxic conditions 25, 26, 27. Moreover, the slope of the VO 2 /work relationship was unaffected by high altitude (3260 m) both in the active treatment group and in the placebo group, suggesting that during effort, compensatory mechanisms allow oxygen delivery to muscles to remain stable.…”

Section: Discussionmentioning

confidence: 97%

Upward Shift and Steepening of the Blood Pressure Response to Exercise in Hypertensive Subjects at High Altitude

Caravita

Faini

Baratto

et al. 2018

JAHA

Self Cite

View full text Add to dashboard Cite

BackgroundAcute exposure to high‐altitude hypobaric hypoxia induces a blood pressure rise in hypertensive humans, both at rest and during exercise. It is unclear whether this phenomenon reflects specific blood pressure hyperreactivity or rather an upward shift of blood pressure levels. We aimed at evaluating the extent and rate of blood pressure rise during exercise in hypertensive subjects acutely exposed to high altitude, and how these alterations can be counterbalanced by antihypertensive treatment.Methods and ResultsFifty‐five subjects with mild hypertension, double‐blindly randomized to placebo or to a fixed‐dose combination of an angiotensin‐receptor blocker (telmisartan 80 mg) and a calcium‐channel blocker (nifedipine slow release 30 mg), performed a cardiopulmonary exercise test at sea level and after the first night's stay at 3260 m altitude. High‐altitude exposure caused both an 8 mm Hg upward shift (P<0.01) and a 0.4 mm Hg/mL/kg per minute steepening (P<0.05) of the systolic blood pressure/oxygen consumption relationship during exercise, independent of treatment. Telmisartan/nifedipine did not modify blood pressure reactivity to exercise (blood pressure/oxygen consumption slope), but downward shifted (P<0.001) the relationship between systolic blood pressure and oxygen consumption by 26 mm Hg, both at sea level and at altitude. Muscle oxygen delivery was not influenced by altitude exposure but was higher on telmisartan/nifedipine than on placebo (P<0.01).ConclusionsIn hypertensive subjects exposed to high altitude, we observed a hypoxia‐driven upward shift and steepening of the blood pressure response to exercise. The effect of the combination of telmisartan/nifedipine slow release outweighed these changes and was associated with better muscle oxygen delivery.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01830530.

show abstract

Section: Discussionmentioning

confidence: 97%

Upward Shift and Steepening of the Blood Pressure Response to Exercise in Hypertensive Subjects at High Altitude

Caravita

Faini

Baratto

et al. 2018

JAHA

Self Cite

View full text Add to dashboard Cite

show abstract

“…In addition, heart failure treatment with angiotensin converting enzyme inhibitors and anti-aldosteronic drugs, noted to improve functional capacity, has been associated with lung diffusion improvement without pulmonary haemodynamic changes [35,36]. Finally treatment with β-blocker agents has been shown to have little to no effect on maximal exercise capacity, but has been associated with an improvement in perceived dyspnoea and ventilatory response to exercise [37] particularly for non-selective β-blockers [38].…”

Section: Is Dyspnoea Related To Left and Right Ventricular Haemodynammentioning

confidence: 99%

“…It has been shown that the impairment in DLCO mirrors the severity of heart failure [40], that DLCO has an independent prognostic role in heart failure [78], and that the alveolar-capillary membrane is recognised as a target of heart failure treatment [38]. Indeed, several categories of heart failure drugs, such as angiotensin converting enzyme inhibitors [35] and anti-aldosteronic drugs [36] improve gas diffusion across the alveolar-capillary membrane, while others have no influence, such as AT1-blockers [79], or even a negative action, such as β1-β2 blockers [38]. Interestingly, when lung over-hydration of subjects with heart failure is reduced by ultrafiltration, lung mechanics improves but DLCO remains unchanged [76].…”

Section: Alveolar-capillary Membrane Dysfunctionmentioning

confidence: 99%

Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors

2016

Self Cite

View full text Add to dashboard Cite

Exertional dyspnoea is among the dominant symptoms in patients with chronic heart failure and progresses relentlessly as the disease advances, leading to reduced ability to function and engage in activities of daily living. Effective management of this disabling symptom awaits a better understanding of its underlying physiology.Cardiovascular factors are believed to play a major role in dyspnoea in heart failure patients. However, despite pharmacological interventions, such as vasodilators or inotropes that improve central haemodynamics, patients with heart failure still complain of exertional dyspnoea. Clearly, dyspnoea is not determined by cardiac factors alone, but likely depends on complex, integrated cardio-pulmonary interactions.A growing body of evidence suggests that excessively increased ventilatory demand and abnormal "restrictive" constraints on tidal volume expansion with development of critical mechanical limitation of ventilation, contribute to exertional dyspnoea in heart failure. This article will offer new insights into the pathophysiological mechanisms of exertional dyspnoea in patients with chronic heart failure by exploring the potential role of the various constituents of the physiological response to exercise and particularly the role of abnormal ventilatory and respiratory mechanics responses to exercise in the perception of dyspnoea in patients with heart failure. @ERSpublications In heart failure, respiratory and peripheral factors play a significant role in exertional dyspnoea development

show abstract

“…The hemodynamic profile and tolerance to exertion was also better in comparison to Atenolol [59], and when compared to Carvedilol (CARNEBI (Multiparametric comparison of CARvedilol, vs. NEbivolol, vs. BIsoprolol in moderate heart failure cardiopulmonary trial), patients with moderate HF had better physical capacity [60].…”

Section: Differential Aspects Of Nebivololmentioning

confidence: 99%

Nebivolol: Does the key lie in β3 agonism?

Arazi¹,

Gonzalez²

2017

Vascul Dis Ther

View full text Add to dashboard Cite

Beta-blockers are drugs indicated in the treatment of multiple cardiovascular pathologies. The review highlights the mechanisms of action of Nebivolol and its particular potential effect on β3 receptors that increases nitric oxide that may mark very significant differences, which are traduced to benefits in clinical results.Nebivolol has an special place in the treatment of adrenergic hypertension associated with tachycardia and emotional stress, more frequently in young individuals, and may be considered adequate even in patients with glucose and lipid metabolism disorders due to its pleiotropic effect.In patients with heart failure, Nebivolol showed effectiveness and safety in patients over 75 years old.Nebivolol showed a reduction of cardiomyocyte apoptosis and improvement of contractile function through a mechanism related to β3 receptor agonism after an acute coronary syndrome.Because of all these actions Nebivolol should be considered not only a third-generation Beta-blocker.

show abstract

Multiparametric comparison of CARvedilol, vs. NEbivolol, vs. BIsoprolol in moderate heart failure: The CARNEBI trial

Cited by 69 publications

References 27 publications

Upward Shift and Steepening of the Blood Pressure Response to Exercise in Hypertensive Subjects at High Altitude

Upward Shift and Steepening of the Blood Pressure Response to Exercise in Hypertensive Subjects at High Altitude

Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors

Nebivolol: Does the key lie in β3 agonism?

Contact Info

Product

Resources

About