DOCSLIB.ORG

For Peer Review Only Journal: BMJ Open

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
For Peer Review Only Journal: BMJ Open BMJ Open BMJ Open: first published as 10.1136/bmjopen-2012-001185 on 19 July 2012. Downloaded from Beta-blocker treatment during pregnancy and adverse pregnancy outcomes: a nationwide population based cohort study For peer review only Journal: BMJ Open Manuscript ID: bmjopen-2012-001185 Article Type: Research Date Submitted by the Author: 20-Mar-2012 Complete List of Authors: Meidahl Petersen, Kasper; Rigshospitalet, University Hospital Copenhagen, Department of Clinical Pharmacology, Q Jimenez-Solem, Espen; Bispebjerg Hospital, Laboratory of Clinical Pharmacology Andersen, Jon Traerup; Bispebjerg Hospital, Department of Clinical Pharmacology Petersen, Morten; Bispebjerg Hospital, Department of Clinical Pharmacology Brødbæk, Kasper; Bispebjerg Hospital, Department of Clinical Pharmacology; Rigshospitalet, Laboratory of Clinical Pharmacology Poulsen, Henrik; Bispebjerg Hospital, Department of Clinical Pharmacology; Rigshospitalet, Laboratory of Clinical Pharmacology K�ber, Lars; Rigshospitalet, Department of Cardiology http://bmjopen.bmj.com/ Torp-Pedersen, Christian; Gentofte Hospital, Department of Cardiology <b>Primary Subject Pharmacology and therapeutics Heading</b>: Secondary Subject Heading: Epidemiology, Evidence based practice CLINICAL PHARMACOLOGY, Maternal medicine < OBSTETRICS, Keywords: EPIDEMIOLOGY on September 26, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 22 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2012-001185 on 19 July 2012. Downloaded from 1 2 3 4 Beta-blocker treatment during pregnancy and adverse pregnancy outcomes: a nationwide 5 population-based cohort study 6 7 8 9 Kasper Meidahl Petersen MB1; Espen Jimenez-Solem MD1; Jon Trærup Andersen MD1; 10 11 Morten Petersen MD1, PhD; Kasper Brødbæk MD1; Henrik Enghusen Poulsen MD, DMSc1; 12 13 Lars Køber MD, DMSc2; Christian Torp-Petersen MD, DMSc3 14 15 For peer review only 16 17 18 Author affiliations 19 20 1: Department of Clinical Pharmacology, Q, Rigshospitalet, University Hospital Copenhagen, 21 22 Denmark 23 24 25 2: Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Denmark 26 27 3: Department of Cardiology, Gentofte Hospital, Gentofte, Denmark 28 29 30 31 Keywords (MeSH): Adrenergic beta-antagonists, pregnancy, small for gestational age infant, 32 premature birth, perinatal mortality. 33 http://bmjopen.bmj.com/ 34 35 Words: 2995 36 37 38 Correspondence to: 39 Kasper Meidahl Petersen 40 Department of Clinical Pharmacology, Q 41 Rigshospitalet, University Hospital Copenhagen on September 26, 2021 by guest. Protected copyright. 42 Tagensvej 20 43 DK-2200 Copenhagen N 44 Denmark 45 46 Tel +45 5123 7716 47 Fax +45 3545 2745 48 E-mail: [email protected] 49 50 51 52 53 54 55 56 57 58 59 1 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 22 BMJ Open: first published as 10.1136/bmjopen-2012-001185 on 19 July 2012. Downloaded from 1 2 3 4 5 6 ABSTRACT 7 8 Objective: To investigate the association between exposure to beta-blockers during pregnancy and 9 10 11 the risk of being born small for gestational age (SGA), preterm birth, and perinatal mortality in 12 13 a nationwide cohort. 14 15 Design: A population-basedFor peer retrospective cohortreview study, using the Danishonly Fertility Database. We 16 17 identified all pregnant women redeeming a prescription for beta-blockers using the National 18 19 20 Prescription Registry. Multivariate logistic regression models were used to assess the association 21 22 between exposure and our outcomes. 23 24 Setting: Register based survey. 25 26 Participants: 911685 births between 1995 and 2008 obtained from the Danish Fertility Database. 27 28 Outcome measures: Being born SGA was defined as having a birth weight below the tenth 29 30 th 31 percentile for the corresponding gestational week. Preterm birth was defined as birth before the 37 32 33 gestational week. Perinatal mortality was defined as either death occurring within the first 28 days http://bmjopen.bmj.com/ 34 35 of life, or stillbirth. Before 2004, foetal deaths were recorded as stillbirths if they occurred after 28 36 37 weeks of gestation, but since then stillbirth is recorded for deaths after 22 gestational weeks. 38 39 40 Results: We identified 2459 pregnancies exposed to beta-blockers. Beta-blocker exposure during 41 on September 26, 2021 by guest. Protected copyright. 42 pregnancy was found to be associated with increased risk of SGA; adjusted OR=1.97 (95% CI, 43 44 1.75–2.23), preterm birth; adjusted OR=2.26 (95% CI, 2.03–2.52) and perinatal mortality; adjusted 45 46 OR=1.89 (95 % CI, 1.25–2.84). Analyses were adjusted for socio-economic and maternal variables. 47 48 We found similar risk profiles for pregnancies exposed to labetalol and for pregnancies exposed to 49 50 51 other beta-blockers. 52 53 Conclusion: We found that exposure to beta-blockers during pregnancy was associated with being 54 55 born SGA, preterm birth and perinatal mortality. Our findings show that labetalol is not safer than 56 57 58 59 2 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 22 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2012-001185 on 19 July 2012. Downloaded from 1 2 3 4 other beta-blockers during pregnancy, and future treatment of pregnant women with beta-blockers 5 6 should therefore be based primarily on the individual needs of the mother and not the unborn child. 7 8 9 ARTICLE SUMMARY 10 11 12 Article focus 13 14 • There is contradictory evidence concerning the consequences of beta-blocker treatment 15 For peer review only 16 during pregnancy. 17 18 • This survey explores the effects of beta-blocker exposure during pregnancy in a Danish birth 19 20 21 cohort comprising all births in Denmark between 1995 and 2008. In addition we compared 22 23 risks associated with exposure to labetalol with exposure to other beta-blockers. 24 25 Key messages 26 27 • Redeeming prescriptions of beta-blockers was found to be significantly associated with 28 29 increased risk of being born SGA, preterm birth, and perinatal mortality. 30 31 32 • We found comparable risk profiles in labetalol-exposed pregnancies and in pregnancies 33 http://bmjopen.bmj.com/ 34 exposed to any other beta-blocker. 35 36 Strengths and limitations of this study 37 38 39 • This study is the largest of its kind to date, and covers an entire nation which minimises risk 40 of selection bias. 41 on September 26, 2021 by guest. Protected copyright. 42 43 • Given the study design, we were not able to adjust for treatment indication and severity of 44 45 maternal disease, nor were we able to rule out confounding by indication, the underlying 46 47 maternal disease, as a possible explanation for our findings. 48 49 50 51 52 53 INTRODUCTION 54 55 56 57 58 59 3 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 22 BMJ Open: first published as 10.1136/bmjopen-2012-001185 on 19 July 2012. Downloaded from 1 2 3 4 Beta-blockers are widely used in the treatment of chronic hypertension,[1-4] migraine,[5] essential 5 6 tremor[6], and various other conditions. There is contradictory evidence concerning the 7 8 consequences of beta-blocker treatment during pregnancy. Some studies report an association 9 10 11 between beta-blocker treatment and small for gestational age (SGA) newborns, and preterm 12 13 birth,[4,7-10] while others do not.[2,11] Preterm birth and being born SGA are both associated with 14 15 increased risk ofFor perinatal mortality.[12,13]peer reviewWe set out to investigate only whether the use of beta- 16 17 blockers during pregnancy was associated with being born SGA, preterm birth and perinatal 18 19 20 mortality in a nationwide survey between 1995 and 2008. 21 22 23 24 METHOD 25 26 Study population 27 28 We used data obtained from three nationwide registries: the Danish Fertility Database,[14] the 29 30 31 Danish National Hospital Register[15], and the National Prescription Register.[16] Data concerning 32 33 income and educational level were obtained respectively from the Income Statistics Register[17] http://bmjopen.bmj.com/ 34 35 and the Danish Education register,[18] both of which are provided by Statistics Denmark. In 36 37 Denmark all citizens are given a unique ten-digit identification number at birth.[19] This number 38 39 40 can be used to link information between nationwide registers. 41 on September 26, 2021 by guest. Protected copyright. 42 Using the Danish Fertility Database we identified 974 805 births between 1995 and 2008. We 43 44 removed 52 603 records lacking information on pregnancy duration and 7681 records with coding 45 46 errors. In addition, we excluded 2836 records with pregnancy-induced hypertension, defined as 47 48 having redeemed an antihypertensive drug prescription after the twentieth week of gestation, but 49 50 51 never before. The final study population thus comprised 911 685 births. 52 53 The Danish Fertility Database contains information on maternal age, date of birth, and 54 55 previous births, as well as on each child’s sex, gestational age, weight, and mortality.[14] 56 57 58 59 4 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 22 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2012-001185 on 19 July 2012. Downloaded from 1 2 3 4 Time of conception is based on ultrasound estimates in early pregnancy, or information on last 5 6 menstrual period. 7 8 Information on redeemed prescriptions was retrieved from the National Prescription Register, 9 10 11 which holds information on date of redemption, quantity, strength, and form.[16] Drugs are coded 12 13 in accordance with the Anatomical Therapeutic Chemical (ATC) classification.
Load more

Recommended publications
  • Angiotensin-Converting Enzyme Inhibitors Or Angiotensin II Receptor Blockers and the Risk of Developing Rheumatoid Arthritis in Antihypertensive Drug Users
    Jong, H.J.I. de, Vandebriel, R.J., Saldi, S.R.F., Dijk, L. van, Loveren, H. van, Cohen Tervaert, J.W., Klungel, O.H. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and the risk of developing rheumatoid arthritis in antihypertensive drug users. Pharmacoepidemiology and Drug Safety: 2012, 21(8), 835-843 Postprint Version 1.0 Journal website http://dx.doi.org/10.1002/pds.3291 Pubmed link http://www.ncbi.nlm.nih.gov/pubmed/22674737 DOI 10.1002/pds.3291 This is a NIVEL certified Post Print, more info at http://www.nivel.eu Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and the risk of developing rheumatoid arthritis in antihypertensive drug users†‡ HILDA J. I. DE JONG1,2,3, ROB J. VANDEBRIEL1, SITI R. F. SALDI3, LISET VAN DIJK4, HENK VAN LOVEREN1,2, JAN WILLEM COHEN TERVAERT5, OLAF H. KLUNGEL3,* ABSTRACT Purpose: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are effective in the treatment of cardiovascular disease. Next to effects on hypertension and cardiac function, these drugs have anti-inflammatory and immunomodulating properties which may either facilitate or protect against the development of autoimmunity, potentially resulting in autoimmune diseases. Therefore, we determined in the current study the association between ACE inhibitor and ARB use and incident rheumatoid arthritis (RA). Methods: A matched case–control study was conducted among patients treated with antihypertensive drugs using the Netherlands Information Network of General Practice (LINH) database in 2001–2006. Cases were patients with a first-time diagnosis of RA. Each case was matched to five controls for age, sex, and index date, which was selected 1 year before the first diagnosis of RA.
    [Show full text]
  • Evaluating Onco-Geriatric Scores and Medication Risks to Improve Cancer Care for Older Patients
    Evaluating onco-geriatric scores and medication risks to improve cancer care for older patients Dissertation zur Erlangung des Doktorgrades (Dr. rer. nat.) der Mathematisch-Naturwissenschaftlichen Fakultät der Rheinischen Friedrich-Wilhelms-Universität Bonn vorgelegt von IMKE ORTLAND aus Quakenbrück Bonn 2019 Angefertigt mit Genehmigung der Mathematisch-Naturwissenschaftlichen Fakultät der Rheinischen Friedrich-Wilhelms-Universität Bonn. Diese Dissertation ist auf dem Hochschulschriftenserver der ULB Bonn elektronisch publiziert. https://nbn-resolving.org/urn:nbn:de:hbz:5-58042 Erstgutachter: Prof. Dr. Ulrich Jaehde Zweitgutachter: Prof. Dr. Andreas Jacobs Tag der Promotion: 28. Februar 2020 Erscheinungsjahr: 2020 Danksagung Auf dem Weg zur Promotion haben mich viele Menschen begleitet und in ganz unterschiedlicher Weise unterstützt. All diesen Menschen möchte ich an dieser Stelle ganz herzlich danken. Mein aufrichtiger Dank gilt meinem Doktorvater Prof. Dr. Ulrich Jaehde für das in mich gesetzte Vertrauen, sowie für die Überlassung dieses spannenden Dissertationsthemas. Die uneingeschränkte Unterstützung, wertvollen Diskussionen und die mitreißende Begeisterung für die Wissenschaft haben mich während aller Phasen der Dissertation stets motiviert, unterstützt und sehr viel Wertvolles gelehrt. Prof. Dr. Andreas Jacobs danke ich herzlich für die Initiierung dieses interessanten Projekts, für die stetige Begeisterung und Unterstützung, sowie für das mir entgegengebrachte Vertrauen. Die ausgezeichnete Zusammenarbeit mit dem Johanniter Krankenhaus Bonn hat ganz maßgeblich zum Gelingen dieser Arbeit beigetragen. Auch danke ich Prof. Dr. Andreas Jacobs herzlich für die Bereitschaft, das Koreferat dieser Arbeit zu übernehmen. Ebenfalls danke ich herzlich Prof. Dr. Yon-Dschun Ko für seine fortwährende Motivation und seinen Einsatz, sowie für das mir geschenkte Vertrauen, dieses Projekt am Johanniter Krankenhaus zu realisieren. Ebenfalls danke ich Prof.
    [Show full text]
  • Medication Risks in Older Patients with Cancer
    Medication risks in older patients with cancer 1 Medication risks in older patients (70+) with cancer and their association with therapy-related toxicity Imke Ortland1, Monique Mendel Ott1, Michael Kowar2, Christoph Sippel3, Yon-Dschun Ko3#, Andreas H. Jacobs2#, Ulrich Jaehde1# 1 Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121 Bonn, Germany 2 Department of Geriatrics and Neurology, Johanniter Hospital Bonn, Johanniterstr. 1-3, 53113 Bonn, Germany 3 Department of Oncology and Hematology, Johanniter Hospital Bonn, Johanniterstr. 1-3, 53113 Bonn, Germany # equal contribution Corresponding author Ulrich Jaehde Institute of Pharmacy University of Bonn An der Immenburg 4 53121 Bonn, Germany Phone: +49 228-73-5252 Fax: +49-228-73-9757 [email protected] Medication risks in older patients with cancer 2 Abstract Objectives To evaluate medication-related risks in older patients with cancer and their association with severe toxicity during antineoplastic therapy. Methods This is a secondary analysis of two prospective, single-center observational studies which included patients ≥ 70 years with cancer. The patients’ medication was investigated regarding possible risks: polymedication (defined as the use of ≥ 5 drugs), potentially inadequate medication (PIM; defined by the EU(7)-PIM list), and relevant potential drug- drug interactions (rPDDI; analyzed by the ABDA interaction database). The risks were analyzed at two different time points: before and after start of cancer therapy. Severe toxicity during antineoplastic therapy was captured from medical records according to the Common Terminology Criteria for Adverse Events (CTCAE). The association between Grade ≥ 3 toxicity and medication risks was evaluated by univariate regression.
    [Show full text]
  • Summary of Product Characteristics
    Health Products Regulatory Authority Summary of Product Characteristics 1 NAME OF THE MEDICINAL PRODUCT Carvedilol Krka 3.125 mg Tablets. 2 QUALITATIVE AND QUANTITATIVE COMPOSITION One tablet contains 3.125 mg carvedilol. Excipients: Each tablet contains 75.375 mg lactose monohydrate and 5 mg sucrose. For a full list of excipients, see section 6.1. 3 PHARMACEUTICAL FORM Tablets. Appearance: Round, slightly biconvex, white bevel edged tablet. 4 CLINICAL PARTICULARS 4.1 Therapeutic Indications Adjunctive therapy for the treatment of symptomatic congestive heart failure to reduce morbidity and increase patient well-being. Treatment of hypertension. 4.2 Posology and method of administration Posology Symptomatic congestive heart failure The dosage must be titrated to individual requirements and patients' clinical status should be monitored for 2 - 3 hours after initiation and any dose increase during up-titration. For those patients receiving diuretics and/or digoxin and/or ACE inhibitors, dosing of these other drugs should be stabilised prior to initiation of Carvedilol Krka treatment. Adults The recommended dose for the initiation of therapy is 3.125 mg twice a day for two weeks. If this dose is tolerated, the dosage should be increased subsequently, at intervals of not less than two weeks, to 6.25 mg twice daily, followed by 12.5 mg twice daily and thereafter 25 mg twice daily. Dosing should be increased to the highest level tolerated by the patient. The recommended maximum daily dose is 25 mg given twice daily in patients weighing less than 85 kg (187 lbs) and 50 mg twice daily in patients weighing more than 85 kg.
    [Show full text]
  • B-Blocker Treatment During Pregnancy and Adverse Pregnancy Outcomes: a Nationwide Population-Based Cohort Study
    Open Access Research BMJ Open: first published as 10.1136/bmjopen-2012-001185 on 19 July 2012. Downloaded from b-Blocker treatment during pregnancy and adverse pregnancy outcomes: a nationwide population-based cohort study Kasper Meidahl Petersen,1 Espen Jimenez-Solem,1 Jon Traerup Andersen,1 Morten Petersen,1 Kasper Brødbæk,1 Lars Køber,2 Christian Torp-Pedersen,3 Henrik Enghusen Poulsen1 To cite: Meidahl Petersen K, ABSTRACT ARTICLE SUMMARY Jimenez-Solem E, Objective: To investigate the association between et al b Andersen JT, . -Blocker exposure to b-blockers during pregnancy and the risk Article focus treatment during pregnancy of being born small for gestational age (SGA), preterm - and adverse pregnancy There is contradictory evidence concerning the birth and perinatal mortality in a nationwide cohort. b outcomes: a nationwide consequences of -blocker treatment during population-based cohort Design: A population-based retrospective cohort pregnancy. study. BMJ Open 2012;2: study, using the Danish Fertility Database. The authors - This survey explores the effects of b-blocker e001185. doi:10.1136/ identified all pregnant women redeeming a prescription exposure during pregnancy in a Danish birth bmjopen-2012-001185 for b-blockers using the National Prescription cohort comprising all births in Denmark between Registry. Multivariate logistic regression models were 1995 and 2008. In addition, we compared risks < Prepublication history for used to assess the association between exposure and associated with exposure to labetalol with this paper is available online. our outcomes. b To view this file please visit exposure to other -blockers. Setting: Register-based survey. the journal online Key messages (http://dx.doi.org/10.1136/ Participants: 911’685 births between 1995 and 2008 - Redeeming prescriptions of b-blockers was bmjopen-2012-001185).
    [Show full text]
  • Detecting Drug±Drug Interactions Using a Database for Spontaneous Adverse Drug Reactions: an Example with Diuretics and Non-Steroidal Anti-In¯Ammatory Drugs
    Eur J Clin Pharmacol -2000) 56: 733±738 DOI 10.1007/s002280000215 PHARMACOEPIDEMIOLOGY AND PRESCRIPTION EugeÁ ne P. van Puijenbroek á Antoine C. G. Egberts Eibert R. Heerdink á Hubert G. M. Leufkens Detecting drug±drug interactions using a database for spontaneous adverse drug reactions: an example with diuretics and non-steroidal anti-in¯ammatory drugs Received: 27 April 2000 / Accepted in revised form: 7 September 2000 / Published online: 7 November 2000 Ó Springer-Verlag 2000 Abstract Objective: Drug±drug interactionsare rela- interval -CI) 1.1±3.7], which may indicate an enhanced tively rarely reported to spontaneous reporting systems eect of concomitant drug use. -SRSs) for adverse drug reactions. For this reason, the Conclusion: The ®ndings illustrate that spontaneous traditional approach for analysing SRS has major limi- reporting systems have a potential for signal detection tationsfor the detection of drug±drug interactions.We and the analysis of possible drug±drug interactions. The developed a method that may enable signalling of these method described may enable a more active approach possible interactions, which are often not explicitly in the detection of drug±drug interactionsafter mar- reported, utilising reports of adverse drug reactions in keting. data sets of SRS. As an example, the in¯uence of con- comitant use of diuretics and non-steroidal anti-in¯am- Key words Drug±drug interaction á matory drugs -NSAIDs) on symptoms indicating a Pharmacovigilance á Spontaneous reporting system decreased ecacy of diuretics was examined using reportsreceived by the NetherlandsPharmacovigilance Foundation Lareb. Introduction Methods: Reportsreceived between 1 January 1990 and 1 January 1999 of patientsolder than 50 yearswere in- Since the early 1960s, spontaneous reporting systems cluded in the study.
    [Show full text]
  • The Work Presented in This Thesis Was Conducted at the Department of Medical Informatics of the Erasmus Medical Center, Rotterdam, the Netherlands
    The work presented in this thesis was conducted at the department of Medical Informatics of the Erasmus Medical Center, Rotterdam, the Netherlands The contribution of all of the participants and staff of the Rotterdam Study is gratefully acknowledged. All the general practitioners and pharmacists of the Ommoord district are gratefully acknowledged for their help with data collection and validation. The work in this thesis is supported by grants from the Netherlands Organisation for Health Research and Development (ZonMw; Priority Medicines Elderly 113102005). The Rotterdam Study is supported by the Erasmus MC and Erasmus University Rotterdam; the Netherlands Organisation for Scientific Research (NWO); the Netherlands Organisation for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the Netherlands Genomics Initiative (NGI); the Ministry of Education, Culture, and Science; the Ministry of Health, Welfare, and Sport; the European Commission (DG XII); and the Municipality of Rotterdam. The generation and management of GWAS genotype data for the Rotterdam Study is supported by the Netherlands Organisation for Scientific Research (NWO) Investments (nr. 175.010.2005.011, 911-03-012). This stuy is funded by the Research Institute for Diseases in the Elderly (014-93-015; RIDE2), the Netherlands Genomics Initiative (NGI) / the Netherlands Organisation for Scientific Research (NWO) project nr. 050-060-810. Financial support for the publication of this thesis was kindly provided by the Department of Medical Informatics of the Erasmus Medical Center, Rotterdam, the Netherlands and the Erasmus University Medical Center Rotterdam. Cover image and lay-out: Nastasia Griffioen Printed by: GVO Drukkers & Vormgevers – www.proefschriften.nl ©Marten van den Berg, 2017 ISBN: 978-94-6332-221-8 For articles published or accepted for publication, the copyright has been transferred to the respective publisher.
    [Show full text]
  • High Blood Pressure, Antihypertensive Medication and Lung Function in A
    Schnabel et al. Respiratory Research 2011, 12:50 http://respiratory-research.com/content/12/1/50 RESEARCH Open Access High blood pressure, antihypertensive medication and lung function in a general adult population Eva Schnabel1,2*, Stefan Karrasch3,4,5, Holger Schulz1,3,5, Sven Gläser6, Christa Meisinger7,11, Margit Heier7,11, Annette Peters8,11, H-Erich Wichmann1,8, Jürgen Behr5,9, Rudolf M Huber5,10 and Joachim Heinrich1, for for the Cooperative Health Research in the Region of Augsburg (KORA) Study Group Abstract Background: Several studies showed that blood pressure and lung function are associated. Additionally, a potential effect of antihypertensive medication, especially beta-blockers, on lung function has been discussed. However, side effects of beta-blockers have been investigated mainly in patients with already reduced lung function. Thus, aim of this analysis is to determine whether hypertension and antihypertensive medication have an adverse effect on lung function in a general adult population. Methods: Within the population-based KORA F4 study 1319 adults aged 40-65 years performed lung function tests and blood pressure measurements. Additionally, information on anthropometric measurements, medical history and use of antihypertensive medication was available. Multivariable regression models were applied to study the association between blood pressure, antihypertensive medication and lung function. Results: High blood pressure as well as antihypertensive medication were associated with lower forced expiratory volume in one second (p = 0.02 respectively p = 0.05; R2: 0.65) and forced vital capacity values (p = 0.01 respectively p = 0.05, R2: 0.73). Furthermore, a detailed analysis of antihypertensive medication pointed out that only the use of beta-blockers was associated with reduced lung function, whereas other antihypertensive medication had no effect on lung function.
    [Show full text]
  • Comparison of the Clinical Outcome of Different Beta-Blockers in Heart Failure Patients: a Retrospective Nationwide Cohort Study
    European Journal of Heart Failure (2014) doi:10.1002/ejhf.81 Comparison of the clinical outcome of different beta-blockers in heart failure patients: a retrospective nationwide cohort study Rasmus Bølling1*, Nikolai Madrid Scheller1,LarsKøber2, Henrik Enghusen Poulsen3,4, Gunnar H. Gislason5, and Christian Torp-Pedersen1 1Institute of Health, Science and Technology, Aalborg University, Denmark; 2Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen; 3Laboratory of Clinical Pharmacology, Rigshospitalet; 4Department of Clinical Pharmacology Bispebjerg Hospital, Copenhagen University Hospital; and 5Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark Received 31 October 2013; revised 9 February 2014; accepted 14 February 2014 Aim To compare survival on different beta-blockers in heart failure. ..................................................................................................................................................................... Methods We identified all Danish patients ≥35 years of age who were hospitalized with a first admission for heart failure and and results who initiated treatment with a beta-blocker within 60 days of discharge. The study period was 1995–2011. The main outcome was all-cause mortality and all-cause hospitalization. Cox proportional hazard models were used to compare survival. The study included 58 634 patients of whom 30.121 (51.4%) died and 46.990 (80.1%) were hospitalized during follow-up. The mean follow-up time was 4.1 years. In an unadjusted model carvedilol was associated with a lower mortality [hazard ratio (HR) 0.737, 0.714–0.761] compared with metoprolol (reference) while bisoprolol was not associated with an increased mortality (HR 1.020, 0.973–1.069). In a model adjusted for possible confounders and stratified according to beta-blocker dosages, patients that received high-dose carvedilol (≥50 mg daily) had a lower all-cause mortality risk (HR 0.873, 0.789–0.966) than patients receiving high-dose (≥200 mg daily) metoprolol (reference).
    [Show full text]
  • Autonomic Dysfunction and Blood Pressure in Glaucoma Patients: the Lifelines Cohort Study
    Glaucoma Autonomic Dysfunction and Blood Pressure in Glaucoma Patients: The Lifelines Cohort Study Nigus G. Asefa,1 Anna Neustaeter,2 Nomdo M. Jansonius,2 and Harold Snieder1 1Department of Epidemiology, Graduate School of Medical Science, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands 2Department of Ophthalmology, Graduate School of Medical Science, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Correspondence: Nigus G. Asefa, PURPOSE. We investigated relationship of glaucoma with measurements related to auto- University Medical Center nomic dysfunction, including heart rate variability (HRV) and blood pressure (BP). Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands; METHODS. Glaucoma was defined using a questionnaire-based algorithm for 86,841 Life- [email protected]. Lines Cohort Study participants. Baseline HRV (root mean square of successive differ- ences [RMSSD]) was calculated from resting electrocardiograms; systolic BP (SBP), dias- Received: April 18, 2020 tolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were oscillometric- Accepted: August 7, 2020 Published: September 15, 2020 based measurements. We used a generalized linear mixed model, adjusted for age, age square, sex, body mass index, and familial relationships to assess the relationship of Citation: Asefa NG, Neustaeter A, baseline HRV and BP (continuous and quartiles), hypertension, and antihypertensive Jansonius NM, Snieder H. medication with glaucoma at follow up (median, 3.8 years). Autonomic dysfunction and blood pressure in glaucoma patients: The RESULTS. The odds ratio (OR) of glaucoma was 0.95 (95% confidence interval [CI], 0.92– lifelines cohort study. Invest 0.99) per unit increase in log-transformed RMSSD (in ms), indicating that autonomous Ophthalmol Vis Sci.
    [Show full text]
  • Module 1 (Part I)
    DE/H/1656/001/MR SmPC Summary of Product Characteristics 1. NAME OF THE MEDICINAL PRODUCT Nebivolol-ratiopharm 5 mg tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains 5 mg nebivolol (as hydrochloride). Excipient with known effect: 142.21 mg of lactose monohydrate/tablet For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Tablet White to off-white, round, biconvex tablet, with quartering lines on one side and plain on the other. The tablet can be divided into equal doses. 4. CLINICAL PARTICULARS 4.1. Therapeutic indications Treatment of essential hypertension. Treatment of stable mild and moderate chronic heart failure in addition to standard therapies in elderly patients ≥ 70 years. 4.2. Posology and method of administration Posology Hypertension Adults The dose is one tablet (5 mg) daily, preferably at the same time of the day. Tablets may be taken with meals. The blood pressure lowering effect becomes evident after 1-2 weeks of treatment. Occasionally, the optimal effect is reached only after 4 weeks. Combination with other antihypertensive agents Beta-blockers can be used alone or concomitantly with other antihypertensive agents. Till date, an additional antihypertensive effect has been observed only when Nebivolol-ratiopharm 5 mg is combined with hydrochlorothiazide 12.5-25 mg. Patients with renal insufficiency In patients with renal insufficiency, the recommended starting dose is 2.5 mg daily. If needed, the daily dose may be increased to 5 mg. Patients with hepatic insufficiency Data in patients with hepatic insufficiency or impaired liver function are limited. Therefore the use of Nebivolol-ratiopharm 5 mg in these patients is contraindicated.
    [Show full text]
  • Uncontrolled and Apparent Treatment Resistant
    Petersen et al. BMC Cardiovascular Disorders (2020) 20:135 https://doi.org/10.1186/s12872-020-01407-2 RESEARCH ARTICLE Open Access Uncontrolled and apparent treatment resistant hypertension: a cross-sectional study of Russian and Norwegian 40–69 year olds Jakob Petersen1*, Sofia Malyutina2,3, Andrey Ryabikov3, Anna Kontsevaya4, Alexander V. Kudryavtsev5, Anne Elise Eggen6, Martin McKee1, Sarah Cook6, Laila A. Hopstock6, Henrik Schirmer6,7,8 and David A. Leon1,6,9 Abstract Background: Uncontrolled hypertension is a major cardiovascular risk factor. We examined uncontrolled hypertension and differences in treatment regimens between a high-risk country, Russia, and low-risk Norway to gain better understanding of the underlying factors. Methods: Population-based survey data on 40–69 year olds with hypertension defined as taking antihypertensives and/or having high blood pressure (140+/90+ mmHg) were obtained from Know Your Heart Study (KYH, N = 2284), Russian Federation (2015–2018) and seventh wave of The Tromsø Study (Tromsø 7, N = 5939), Norway (2015–2016). Uncontrolled hypertension was studied in the subset taking antihypertensives (KYH: N = 1584; Tromsø 7: 2792)and defined as having high blood pressure (140+/90+ mmHg). Apparent treatment resistant hypertension (aTRH) was defined as individuals with uncontrolled hypertension on 3+ OR controlled on 4+ antihypertensive classes in the same subset. Results: Among all those with hypertension regardless of treatment status, control of blood pressure was achieved in 22% of men (KYH and Tromsø 7), while among women it was 33% in Tromsø 7 and 43% in KYH. When the analysis was limited to those on treatment for hypertension, the percentage uncontrolled was higher in KYH (47.8%, CI 95 44.6–50.9%) than Tromsø 7 (38.2, 36.1–40.5%).
    [Show full text]