Potential risk of beta-blockade withdrawal in congestive heart failure due to abrupt autonomic changes.

• Beta-Blockers reduce mortality in patients with congestive heart failure and a proposed mechanism has been changes of autonomic tone. Heart rate variability is a non-invasive tool to estimate cardiac autonomic tone. The aim was to study changes of heart rate variability in patients with congestive heart failure on placebo, on the beta1-selective antagonist metoprolol or 24 h after metoprolol withdrawal. Forty-five patients with congestive heart failure were studied with Holter recordings. Heart rate variability measurements were performed before, after 6-12 months of treatment with 150 mg metoprolol/placebo, or 24 h after discontinued metoprolol. After treatment, patients on beta-blockade had a significantly longer mean RR interval and changes of heart rate variability, suggesting elevated vagal tone. Patients monitored in the rebound phase of beta-blocker withdrawal had a significant vagal reduction to the level of the placebo group. There was also a nonsignificant trend towards increased sympathetic tone (LF/HF over 24 h), compared with the beta-blockade group. Heart rate variability indicates an elevated vagal tone during treatment with metoprolol but beta-blockade withdrawal shifts the autonomic balance towards lower vagal and higher sympathetic tone within 24 h. These results could imply a potential risk when abruptly discontinuing beta-blockade medication in these patients.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Adolescent

Adrenergic beta-Antagonists

adverse effects

Adult

Aged

Electrocardiography

Ambulatory

drug effects

Female

Follow-Up Studies

Heart Failure

drug therapy

physiopathology

Heart Rate

drug effects

Humans

Male

Metoprolol

adverse effects

Middle Aged

Myocardial Ischemia

chemically induced

physiopathology

Prognosis

Retrospective Studies

Risk Factors

Substance Withdrawal Syndrome

physiopathology

Vagus Nerve

drug effects

physiopathology

Ventricular Fibrillation

chemically induced

physiopathology

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)