Lipophilic Versus Hydrophilic Beta(1) Blockers and the Cardiac Sympatho-vagal Balance During Stress and Daily Activity in Patients After Acute Myocardial Infarction

Overview

Journal Heart

Date 1998 Apr 16

PMID 9538308

Citations 6

Authors

A Kardos

V Long

J Bryant

J Singh

P Sleight

B Casadei

Affiliations

Soon will be listed here.

Abstract

Objective: To compare the effects of a lipophilic and a hydrophilic beta(1) blocker on cardiac sympatho-vagal balance during daytime activity and stress in patients four to six weeks after myocardial infarction.

Design: Randomised, double blind, crossover study comparing the effect of atenolol (50 mg once daily) with metoprolol CR (100 mg once daily) with treatment periods of four weeks.

Setting: Large teaching hospital.

Patients: 50 patients (45 male, 5 female, age range 40 to 75 years), four to six weeks after an acute myocardial infarction.

Methods: At the end of each treatment period the 24 hour heart rate variability, heart rate variability power spectra during head up tilt and mental stress, baroreflex sensitivity, and exercise performance were evaluated.

Results: During daytime activity and during orthostatic and mental stress, both heart rate and the ratio between the low and high frequency spectral components of the heart rate variability were significantly lower with atenolol. Conversely, there was no difference between treatments in baroreflex sensitivity and resting plasma catecholamines. Exercise duration and peak oxygen consumption did not differ between treatments, but the heart rate during submaximal and peak exercise was significantly lower with atenolol.

Conclusions: At the doses used in this study, atenolol achieved greater beta(1) adrenergic blockade than metoprolol CR and this was associated with significant inhibition of vagal withdrawal during stress. This suggests that peripheral blockade of beta(1) adrenergic receptors may be more important than central blockade in preventing stress induced vagal withdrawal in patients after myocardial infarction.

Citing Articles

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References

Dahlof C, Dimenas E, Olofsson B . Documentation of an instrument for assessment of subjective CNS-related symptoms during cardiovascular pharmacotherapy. Cardiovasc Drugs Ther. 1989; 3(6):919-27. DOI: 10.1007/BF01869582. View

Cook J, BIGGER Jr J, Kleiger R, Fleiss J, Steinman R, Rolnitzky L . Effect of atenolol and diltiazem on heart period variability in normal persons. J Am Coll Cardiol. 1991; 17(2):480-4. DOI: 10.1016/s0735-1097(10)80119-6. View

BIGGER Jr J, Fleiss J, Steinman R, Rolnitzky L, Kleiger R, Rottman J . Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation. 1992; 85(1):164-71. DOI: 10.1161/01.cir.85.1.164. View

Schroder H . Cytochrome P-450 mediates bioactivation of organic nitrates. J Pharmacol Exp Ther. 1992; 262(1):298-302. View

Bristow J, BROWN Jr E, Cunningham D, Goode R, Howson M, Sleight P . The effects of hypercapnia, hypoxia and ventilation on the baroreflex regulation of the pulse interval. J Physiol. 1971; 216(2):281-302. PMC: 1331939. DOI: 10.1113/jphysiol.1971.sp009525. View

Lewis P, Haeusler G . Reduction in sympathetic nervous activity as a mechanism for hypotensive effect of propranolol. Nature. 1975; 256(5516):440. DOI: 10.1038/256440a0. View

Wikstrand J, Kendall M . The role of beta receptor blockade in preventing sudden death. Eur Heart J. 1992; 13 Suppl D:111-20. View

Flapan A, Wright R, Nolan J, Neilson J, Ewing D . Differing patterns of cardiac parasympathetic activity and their evolution in selected patients with a first myocardial infarction. J Am Coll Cardiol. 1993; 21(4):926-31. DOI: 10.1016/0735-1097(93)90349-6. View

Niemela M, Airaksinen K, Huikuri H . Effect of beta-blockade on heart rate variability in patients with coronary artery disease. J Am Coll Cardiol. 1994; 23(6):1370-7. DOI: 10.1016/0735-1097(94)90379-4. View

10.

Pankow D, Damme B, Schror K . Acetylsalicylic acid--inducer of cytochrome P-450 2E1?. Arch Toxicol. 1994; 68(4):261-5. DOI: 10.1007/s002040050066. View

11.

Airaksinen K, Niemela M, Huikuri H . Effect of beta-blockade on baroreflex sensitivity and cardiovascular autonomic function tests in patients with coronary artery disease. Eur Heart J. 1994; 15(11):1482-5. DOI: 10.1093/oxfordjournals.eurheartj.a060418. View

12.

Tuininga Y, Crijns H, Brouwer J, van den Berg M, Man int Veld A, Mulder G . Evaluation of importance of central effects of atenolol and metoprolol measured by heart rate variability during mental performance tasks, physical exercise, and daily life in stable postinfarct patients. Circulation. 1995; 92(12):3415-23. DOI: 10.1161/01.cir.92.12.3415. View

13.

Casadei B, Moon J, Johnston J, Caiazza A, Sleight P . Is respiratory sinus arrhythmia a good index of cardiac vagal tone in exercise?. J Appl Physiol (1985). 1996; 81(2):556-64. DOI: 10.1152/jappl.1996.81.2.556. View

14.

Hills M, Armitage P . The two-period cross-over clinical trial. Br J Clin Pharmacol. 1979; 8(1):7-20. PMC: 1429717. DOI: 10.1111/j.1365-2125.1979.tb05903.x. View

15.

Scott E . The effects of atenolol on spontaneous and reflex activity of the sympathetic nerves in the anaesthetized cat. Br J Pharmacol. 1981; 73(3):609-16. PMC: 2071703. DOI: 10.1111/j.1476-5381.1981.tb16795.x. View

16.

Julian D, Prescott R, Jackson F, SZEKELY P . Controlled trial of sotalol for one year after myocardial infarction. Lancet. 1982; 1(8282):1142-7. DOI: 10.1016/s0140-6736(82)92225-5. View

17.

DeBoer R, Karemaker J, Strackee J . Comparing spectra of a series of point events particularly for heart rate variability data. IEEE Trans Biomed Eng. 1984; 31(4):384-7. DOI: 10.1109/TBME.1984.325351. View

18.

Coker R, Koziell A, Oliver C, Smith S . Does the sympathetic nervous system influence sinus arrhythmia in man? Evidence from combined autonomic blockade. J Physiol. 1984; 356:459-64. PMC: 1193175. DOI: 10.1113/jphysiol.1984.sp015476. View

19.

Yusuf S, Peto R, Lewis J, Collins R, Sleight P . Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985; 27(5):335-71. DOI: 10.1016/s0033-0620(85)80003-7. View

20.

Conway P, Tejani-Butt S, Brunswick D . Interaction of beta adrenergic agonists and antagonists with brain beta adrenergic receptors in vivo. J Pharmacol Exp Ther. 1987; 241(3):755-62. View