Beta Blockers for Younger Patients?

[Bad Mad]

Went for my 10/12 week review yesterday......after I had surgery to replace (re-do) my aortic valve and reduction of a mildly dilated ascending aorta.

When I produced my list of medications, my surgeon was surprised that I was taking (still) a beta blocker (atenolol) since my operation.
My resting HR at the minute is 50 or below

He pointed to the fact that I was young (30 years old) and he would only have me on a Beta if other medications/combinations didn't couldn't keep my BP at 120/80 or below. I am have also been taking perindopril (ace inhibitor) for this past 18 months.

He suggested that my doctor should take enough interest to get the best treatment (if any) to control my BP.
I was hoping that others could maybe suggest:

- Remedies that have worked for you?

- If after AVR your BP was lower than before surgery, because of a now normally functioning valve? BTW my valve was bi-cuspid.

 

[pamela]

Atenolol is used as BP and HR control post-op due to heart remodelling. Since the muscle needs to work harder to achieve life-sustaining baseline pressures. Like the way a pinched hose will rev up a pump and then gush water right after it is released with the pump taking a short while to settle into a slower rpm, your heart will continue overworking until a new normal baseline is established.

Pre-surgery I had PVC's, moderate mitral valve leakage, severe LVH and normal BP. Once I had valve replacement surgery I had a higher HR and moderately high BP. I continued 25 mgs metapropol with diaretics for 6 months postop and my cardiologist discontinued all meds but for the 325 mgs ASA/daily as an anticoagulant.

Time and good cardiac rehab will do wonders. Your annual echo should provide your doctor with the info he needs to determine if he's able to decrease your meds and/or find a more appropriate treatment, now that you are apparently reaching those healthier normals. Good luck and hopes for continued improvement.

 

[Mike C]

How about looking at Losatran, which is a blood pressure medication but is also being used in clincial trials as it was shown to reduce aneurysm in marfan mice.

 

[Susan BAV]

Just my experience...

Just my experience...

Following valve replacement, my bp was no longer high. I was so excited that I no longer had to take any meds at all, except for my little daily aspirin. My family doctor, one whom others here might refer to as primary care physician, told me that my bp would go back up within months, and that he had seen it many times following OHS. He was correct. When I went back in to see my cardio for my annual, I needed to go back on a bp med. He put me on a med called Micardis, which he said was like a second generation ACE inhibitor. It works very well for me. My bp has been excellent with this med.

Take care and best wishes,

 

[Bad Mad]

Thanks for replies folks.

I understand the logic behind Beta's especially post-op, but I also realise that they shouldn't be for everyone.

As I am very active and would have had a good level of fitness before surgery, (I ran 3 miles last night ) I suspect that my resting HR shouldn't be a concern at this stage without a Beta. I guess my surgeon knew that, thus his concern. AS for the BP? Well who know's but I sure would rather try other approaches 1st.

I know the side effects associated with Beta's particularly if you are very active, so I contacted my GP today, and he said he is more then happy to try other approaches and he will see me next week. In the mean time I have reduced my BB dosage to 25mg of Atenolol instead of my daily 50mg.

Mike: I have heard about that trial...I thought you might have asked first though -
"Are you a man or a mouse?!"

I must ask my doctor about that one Susan. I am still taking Perindopril/Coversyl (ace inhibitor) and it worked for me on it's own, ok before surgery, so here's hoping it or something simple like it will do the trick again

 

[alpha 1]

Pamela,
what is severe LVH? Since I don't get much from my doctors, I get a lot of questions answered from you guys. I am trying to get on the ball with them though. Ill just keep asking them till I get some answers. Are you doing ok now?

 

[pamela]

Pamela,
what is severe LVH? Since I don't get much from my doctors, I get a lot of questions answered from you guys. I am trying to get on the ball with them though. Ill just keep asking them till I get some answers. Are you doing ok now?

LVH is Left Ventricle Hypertrophy. Since my heart had to work so incredibly hard to deliver my body's worth of blood through an opening smaller in diameter than a regular lead pencil, the heart muscle got very strong and bulky. It was actually getting to the point that the chamber wall thickness was inhibiting my mitral valve leaflets.

Thankfully, my heart regained a normal physiology after valve replacement and my blood pressure and heart rates were excellent until the pannus ingrowth on the new valve changed the playing field again.

I hope that explains it?

 

[aussigal]

I was told by my surgeon and cardio that I will be on the beta-blocker forever because it reduces the forcefullness of the thumping/pumping of the heart. This helps to prevent further degeneration of our delicate tissues that are faulty because of the connective tissue disorder we have. I was previously on the coversyl as well as the BB but have only needed the BB for the last year or so. Unless you have other issues I dont see why you wouldnt be allowed (under supervision of course) to drop one of the blood pressure meds.

 

[Bad Mad]

Went to see my GP today. He decided to stop the Beta altogether (for now) and continue just with the 4mg of coversyl, before restesting in 2 weeks.

Whilst he thinks that Beta's are extremely effective in treating BP, he understands my surgeon's position, citing that generally they try to avoid Beta's in patients under 55, if possible.
He referred to the Ascot Study which looked at the potential harm caused by the drug, and also other more useful alternatives.
I came across these two articles, whichwere not particlarly favourable of beta's as a first line of treatment for BP.

Prevention of target organ damage with modern antihypertensive agents][[/B http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=16981424&cmd=showdetailview&indexed=google


Páll D, Katona E, Juhász M, Paragh G.
Orvos- és Egészségtudományi, Centrum, I. Belgyógyászati Klinika, Debrecen.

This review summarises the recent epidemiological data on hypertension, .........Because the pathogenesis of hypertension is extremely complex, the therapy most likely requires a combined drug administration. The modern third generation dihydropyridine calcium channel blocker, amlodipine, not only has a favourable antihypertensive and anti-ischemic effect, but anti-atherosclerosis properties as well. There are plenty of evidence which demonstrate that lisinopril, a first line antihypertensive agent, has a positive effect in the treatment of left ventricular hypertrophy, retinopathy and nephropathy, and also has a favourable outcome after myocardial infarction and in heart failure. The combined administration of the two drugs leads to a favourable additive effect, with a decrease in the number and severity of side effects. The results of the ASCOT study proved a favourable effect with amlodipine based, combination therapy with an ACE-inhibitor, compared with the traditional beta-blockers and diuretics. The data of the CAFE sub-study showed, that in spite of the similar peripheral antihypertensive effect, the amlodipine based therapy decreased the central aortic pulse pressure to a greater extent. The central aortic pressure showed a good correlation with the end-points of the study, respectively. The results of the Hungarian multicenter study (HAMLET) proved the effective and safe administration of the two drugs in combination. Based on the above evidence, the fixed-dose combination of the CCB-ACE inhibitor (amlodipine-lisinopril) has not only effective blood pressure reducing properties, but also results in cardiovascular risk reduction, good tolerability and favourable compliance.

More research on beta-blockers (November 2005)
http://www.bpassoc.org.uk/research/medicines_research.htm

In a recent paper in the Lancet, results from a review of research on high blood pressure and the use of beta-blockers has found that these medicines may not be the best choice for treating high blood pressure.

Researchers reviewed data from 20 different studies where patients had been either given a beta-blocker to treat their high blood pressure, a medicine from a different group or a dummy medication (placebo).

They found that beta-blockers were not as effective as some other medications in reducing stroke. When the effect of beta-blockers was compared with that of dummy medications the researchers found that although beta-blockers reduced the number of strokes people had when compared to taking no medicines at all, the reduction was a lot less than expected from previous research.

The researchers conclude that in comparison with other medicines to lower blood pressure, the effect of beta-blockers is less than optimum, with a raised risk of stroke. They believe that beta-blockers should not remain a first choice in the treatment of high blood pressure and suggest that people taking beta-blockers may benefit from being moved onto other medication. However, they warn that any such change should be carried out slowly and under the supervision of a doctor.