PURPOSE: We sought to determine whether propranolol has adverse effects on cognitive function, depressive symptoms, and sexual function in patients treated for diastolic hypertension. SUBJECTS AND METHODS: We performe...
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PURPOSE: We sought to determine whether propranolol has adverse effects on cognitive function, depressive symptoms, and sexual function in patients treated for diastolic hypertension. SUBJECTS AND METHODS: We performed a placebo-controlled trial among 312 men and women, 22 to 59 years of age, who had untreated diastolic hypertension (90 to 104 mm Hg). Patients were randomly assigned to treatment with propranolol (80 to 400 mg/day) or matching placebo tablets. Thirteen tests of cognitive function were assessed at baseline, 3 months, and 12 months. Five tests measured reaction time to, or accuracy in, interpreting visual stimuli;one test measured the ability to acquire, reproduce, and change a set of arbitrary stimulus-response sets;and seven tests measured memory or learning verbal information. Depressive symptoms and sexual function were assessed by questionnaires at baseline and 12 months. RESULTS: There were no significant differences by treatment assignment for 11 of the 13 tests of cognitive function at either 3 or 12 months of follow-up. Compared with placebo, participants pants treated with propranolol had slightly fewer correct responses at 3 months (33 +/- 3 [mean +/- SD] versus 34 +/- 2, P = 0.02) and slightly more errors of commission at 3 months (4 +/- 5 versus 3 +/- 3, P = 0.04) and at 12 months (4 +/- 4 versus 3 +/- 3, P = 0.05). At 12 months, depressive symptoms and sexual function and desire did not differ by treatment assignment. CONCLUSIONS: Treatment of hypertension with propranolol had limited adverse effects on tests of cognitive function that were of questionable clinical relevance, and there were no documented adverse effects on depressive symptoms or sexual function. Selection of beta-blockers for treatment of hypertension should be based on other factors. Am J Med. 2000;108: 359-365. (C) 2000 by Excerpta Medica, Inc.
Background Some patients with heart failure (HF) may have a marked improvement in left ventricular ejection fraction (LVEF) after long-term p-blockade. We compared the clinical characteristics and the prognosis of the...
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Background Some patients with heart failure (HF) may have a marked improvement in left ventricular ejection fraction (LVEF) after long-term p-blockade. We compared the clinical characteristics and the prognosis of these patients with those of other patients. Methods One hundred seventy-one patients with chronic HF were assessed before and after 9 to 12 months of maintenance therapy with metoprolol or carvedilol. Results Thirty-eight patients (22%) showed an increase in their LVEF ! 15 units (from 20% +/- 8% to 43% +/- 10%). Compared with the other patients (LVEF change from 21% +/- 7% to 26% +/- 9%, P < .0001 for differences between groups), these patients also had a greater decline in the left ventricular end-diastolic volume (from 175 +/- 74 mL/m(2) to 113 36 mL/m(2)) and in the right atrial, mean pulmonary artery, and pulmonary wedge pressures, with a greater increase in the cardiac index, stroke volume index, stroke work index, and maximal functional capacity. Their long-term prognosis was excellent, with a 2-year cumulative survival rate of 95%, versus 81% for the other patients, and a hospitalization-free survival rate of 73%, versus 50% for the other patients (all P < .05). By means of multivariate analysis, only the nonischemic cause of HF and the mean arterial pressure at baseline were independently associated with an increase of greater than or equal to0.15 in LVEF. Conclusions Patients who show a marked improvement in their LVEF after long-term p-blockade have an excellent prognosis and have a high prevalence of nonischemic HF and a higher blood pressure at baseline.
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