Use of beta-blockers and effects on heart rate and blood pressure post-acute coronary syndromes: are we on target
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Authors
Herman, MichaelDonovan, Jennifer
Tran, Maichi
McKenna, Brigid
Gore, Joel M.
Goldberg, Robert J.
Tighe, Dennis A.
UMass Chan Affiliations
Department of Medicine, Division of Cardiovascular MedicineDocument Type
Journal ArticlePublication Date
2009-08-25Keywords
Acute Coronary SyndromeAdrenergic beta-Antagonists
Aged
Blood Pressure
Dose-Response Relationship, Drug
Female
Heart Rate
Humans
Male
Metoprolol
Middle Aged
Bioinformatics
Biostatistics
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
BACKGROUND: beta-blockers have been shown to benefit patients after myocardial infarction by decreasing mortality, sudden cardiac death, and reinfarction. Although beta-blockers are recommended for all patients with acute coronary syndromes (ACS) without contraindications, a target heart rate (HR) is recommended only for patients with unstable angina/non ST-elevation myocardial infarction. A contemporary series documenting trends in beta-blocker usage and achieved HR and blood pressures (BP) is not available. The study objectives were to monitor trends in HR and BP in relation to beta-blocker use in a contemporary series of patients with ACS. METHODS: In this observational study, 300 consecutive patients with proven ACS had HR and BP values collected hourly from admission until hospital discharge and averaged at multiple intervals throughout hospital stay. Data on baseline demographic characteristics, beta-blocker doses, and titration schedules, procedures performed, cardiac regimens, concurrent medical issues, and contraindications to therapy were collected. RESULTS: Only 5.3% achieved an average HR of 50 to 60 beat/min throughout the hospital stay. Overall, the average HR was 74 beat/min and average BP was 115/64 mm Hg. Admission daily doses of metoprolol averaged 58 mg compared to discharge daily doses of 88 mg; only 52% of patients had dosage increases. CONCLUSIONS: Although effective levels of BP were maintained during hospitalization for an ACS, target HRs were generally not achieved. Future studies are needed to determine the relationship between treatment objectives and clinical outcomes in the present era of ACS management.Source
Am Heart J. 2009 Sep;158(3):378-85. Link to article on publisher's siteDOI
10.1016/j.ahj.2009.06.023Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47210PubMed ID
19699860Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.ahj.2009.06.023