Listing a study does not mean it has been evaluated by the U. Federal Government. Read our disclaimer for details. Results First Posted : February 27, Last Update Posted : February 27, Study Description. The goal of this proposal is to compare Nebivolol and Atenolol with respect to the following parameters: Plaque within arteries supplying the heart in terms of its volume and composition as assessed by ultrasound within these arteries.
Ability of small arteries in the heart to open up and deliver an enhanced blood supply in response to drug called Adenosine routinely used in the cardiac catheterization laboratory as assessed by pressure and flow detecting catheters within these arteries. Ability of the inner lining of arteries that supply the heart to release a relaxing compound called nitric oxide in response to injection of Acetylcholine also used in the cardiac catheterization laboratory as assessed by squirting dye into these arteries Local forces that affect blood flow in the arteries supplying the heart as assessed by superimposing the above data into complex maps created offline at Georgia Institute of Technology.
Detailed Description:. The coronary shear stress profile measured using 3 dimensional vessel reconstruction, flow velocity measurements, and computational fluid dynamics. Endothelial function as determined by the response of quantitative coronary angiography and Doppler assessment to intracoronary acetylcholine challenge. FDA Resources. Arms and Interventions. Other Names: Senormin Tenormin. Outcome Measures. Eligibility Criteria.
Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. The risk of myocardial infarction is increased for older patients during the first month of withdrawal from cardioselective beta-blockers and this increased risk continues for six months. There are no specific guidelines for withdrawing beta-blockers.
The dose could be halved every week for patients who needed to withdraw from treatment more rapidly. We have now added the ability to add replies to a comment. Simply click the "Reply to comment" button and complete the form. Your reply, once signed off, will appear below the comment to which you replied if multiple replies to a comment, they will appear in order of submission.
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Cardiovascular system Medicine indications Pharmacology. Beta-blockers for cardiovascular conditions: one size does not fit all patients Metoprolol succinate accounts for almost three-quarters of the beta-blockers dispensed in New Zealand. Please login to save this article. Log in. Key practice points: Beta-blockers are a diverse group of medicines and prescribers should consider their different properties, along with the presence of co-morbidities, to individualise care for patients with cardiovascular conditions When a beta-blocker is initiated, a slow upwards titration of dose is recommended to minimise adverse effects.
Beta-blockers should also be withdrawn slowly, ideally over several months, to prevent rebound symptoms such as resting tachycardia. From months onwards post-myocardial infarction, consider withdrawing beta-blockers for patients without heart failure or arrhythmias, if re-vascularisation has occurred Bisoprolol is an alternative to metoprolol succinate in many cases; both are once-daily cardioselective beta-blockers that are less likely to cause fatigue and cold extremities than non-specific beta-blockers and are often preferred for patients with co-existing chronic obstructive pulmonary disorder COPD because they cause less bronchoconstriction.
Reliance on one medicine may cause problems The recent disruption of the supply of metoprolol succinate where dispensing was limited to fortnightly or monthly amounts highlights the risk of depending on one beta-blocker. What is the difference between metoprolol succinate and metoprolol tartrate? The pharmacology of beta-blockers All beta-blockers produce competitive antagonism of beta-adrenoceptors in the autonomic nervous system.
Non-selective, cardioselective and vasodilating beta-blockers Beta-blockers are classified according to their adrenoceptor binding affinities Table 1 , the degree of which varies within each class.
Table 1 : Properties of beta-blockers subsidised in New Zealand. Beta-blockers can be water or lipid soluble Water-soluble beta-blockers, e. Beta-blockers may influence other medicines All beta-blockers can potentiate bradycardia, hypotension and cardiac effects caused by other medicines, e. Cardiovascular indications for beta-blockers The indications for beta-blockers have shifted over the years.
Stable angina: preference and co-morbidities determines treatment choice Beta-blockers or calcium channel blockers are recommended as the first-line anti-anginal medicines. Arrhythmias: bisoprolol and metoprolol succinate are often preferred Beta-blockers are the first-line treatment for long-term symptomatic rate control in patients with a range of cardiac arrhythmias, including atrial fibrillation and ventricular tachycardia.
Hypertension: beta-blockers are fourth-line For patients with uncomplicated hypertension beta-blockers are generally a fourth-line option as angiotensin converting enzyme ACE inhibitors, angiotensin II receptor blockers ARBs , diuretics or calcium channel blockers are associated with better outcomes. Post-myocardial infarction: initiated in secondary care, but when should they be stopped?
The optimal duration of treatment post-myocardial infarction is uncertain There are two reasons why the optimal duration of beta-blocker treatment post-myocardial infarction is uncertain: 16 Reperfusion techniques and the routine use of statins and anti-platelet medicines post-myocardial infarction mean that patients now gain less benefit from the use of beta-blockers than they did decades ago There are no recent prospective randomised studies assessing the long-term benefits of beta-blockers in patients with uncomplicated myocardial infarction A systematic review of sixty trials that divided studies into either the reperfusion era or the pre-reperfusion era, found that beta-blockers reduced mortality in patients post-myocardial infarction in the pre-reperfusion era, but not the reperfusion era.
Minimising the adverse effects of beta-blockers The adverse effect profile varies between beta-blockers according to their properties Table 1. Initiating beta-blockers: start low and go slow if treating heart failure Beta-blockers should be started at a low dose and slowly titrated to maximum tolerated dose when used to treat patients with heart failure.
Beta-blockers are usually not recommended in patients with asthma Beta-blockers should generally be avoided in patients with asthma. Cardioselective beta-blockers are generally safe and beneficial in patients with COPD There is evidence that beta-blockers are under-prescribed to patients with COPD, yet they provide significant benefit to those with co-existing heart failure; 23 cardioselective beta-blockers are preferred.
Cardioselective beta-blockers may reduce peripheral vasoconstriction and fatigue Cardioselective beta-blockers, e. Water soluble beta-blockers are less likely to cause sleep disturbances Malaise, vivid dreams, nightmares and in rare cases hallucinations may be caused by lipid-soluble beta-blockers crossing the blood brain barrier.
Indication Recommendation Co-morbidities and considerations Angina All beta-blockers are considered to be equally effective although bisprolol or metoprolol may be preferred. Celiprolol and pindolol tend not to be used Cardioselective beta-blockers, e. Withdrawal of beta-blockers is sometimes appropriate Treatment with beta-blockers is generally long-term, but it should not be regarded as indefinite.
Stopping treatment: go slow to get low Beta-blockers should be withdrawn slowly to prevent the onset of a withdrawal syndrome which in serious cases may include ischaemic cardiac symptoms, e.
References Ministry of Health. Pharmaceutical Claims Collection. Australian Government. Medicare statistics. Available from: www. Cardio-selective beta-blocker: pharmacological evidence and their influence on exercise capacity. Cardiovasc Ther ;— The role of the new beta-blockers in treating cardiovascular disease.
Am J Hypertens ;S—S. NZF v In some patients with certain risk factors, this may precipitate heart failure. If this occurs, heart failure should be treated according to current guidelines. Beta blockers should not be suddenly stopped, especially in patients with coronary artery disease. Heart attacks and ventricular arrhythmias have been reported in patients who abruptly discontinue beta blockers. When possible, beta blocking agents should be avoided in patients with bronchospastic diseases, such as asthma.
Concomitant use could exacerbate bronchial disease. If it is necessary to use beta blockers, cardioselective ones are preferred. The use of non-cardioselective beta blockers, such as carvedilol, is not recommended.
Atenolol dosing should be reduced in patients with renal disease or renal impairment as the excretion of the drug is slowed. A randomized controlled clinical trial published by The Lancet suggests that patients who have surgery while on beta blockers metoprolol specifically are at an increased risk of a serious outcome such as heart attack or stroke.
However, it is not advisable to stop the beta-blocker for surgery if a patient has been stabilized on it. It is important to know it may be hard to notice signs of hypoglycemia in diabetic patients, such as tachycardia, because they will be masked by the effects of the beta blocker.
The dizziness and hypotension caused by metoprolol and atenolol can increase the risk and incidence of falls, which could be dangerous or lead to head injuries. Caution should be taken in older adults who are already at an increased risk of falls. Metoprolol is a prescription medication that is classified as a cardioselective beta blocker.
It is available in immediate-release oral tablets, extended-release tablets and capsules, injectable solution, and oral powder. Atenolol is a cardioselective beta blocker that is available by prescription only.
It is available in immediate-release oral tablets. Metoprolol and atenolol are each cardioselective beta blockers, and the pharmacology of how they work is similar, but they are not exactly the same. Metoprolol has two forms available, one short-acting and one long-acting, and may be dosed once or twice daily depending on the formulation.
Metoprolol is also lipophilic, meaning it tends to dissolve in more fatty lipid environments. For this reason, taking Metoprolol with a meal is typically recommended. Atenolol is dosed once daily and is hydrophilic. Atenolol dissolves in more aqueous environments, and therefore only needs to be taken with a glass of water. Data suggests that these two drugs have similar outcomes in hypertensive patients, however long term cardiovascular disease outcomes, such as decreased morbidity, may be more favorable with metoprolol.
Metoprolol is in Pregnancy Category C. There are no well-controlled studies to establish safety in pregnancy. Consult a physician regarding taking Metoprolol while pregnant or breastfeeding. Atenolol is in Pregnancy Category D. It is contraindicated and should not be taken during pregnancy.
Consult a doctor regarding steps to take while planning pregnancy or breastfeeding. While there is no direct chemical interaction between alcohol and beta blockers like metoprolol and atenolol, alcohol consumption does cause your blood pressure to fall.
The combined effect of the drugs and alcohol may put you at risk of fainting or falling and injuring yourself. Skip to main content Search for a topic or drug. Metoprolol vs. By Kristi C.
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