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Journal of Clinical Hypertension... Jul 2009Beta-blockers are prescribed for a variety of cardiovascular conditions including hypertension, heart failure, primary treatment of myocardial infarction (MI), and... (Review)
Review
Beta-blockers are prescribed for a variety of cardiovascular conditions including hypertension, heart failure, primary treatment of myocardial infarction (MI), and secondary prevention of ischemic cardiac events. Yet they remain underprescribed in populations at increased risk for cardiovascular disease because of tolerability and safety concerns. Beta-blockers are heterogeneous with respect to pharmacokinetic and pharmacodynamic effects. "Original" agents were nonselective, blocking both beta1-adrenoceptors and beta2-adrenoceptors. Later, new agents were developed with selectivity for beta1-adrenoceptors, and were subsequently followed by beta-blockers, which exhibit additional effects, such as vasodilation. Among newer agents, labetalol, carvedilol, and nebivolol have been approved for use in the United States. Nebivolol possesses both beta1-selectivity and nitric oxide-mediated vasodilatory effects, while carvedilol has attractive effects on insulin resistance and exhibits antioxidant effects. Newer beta-blockers may overcome concerns about efficacy, adverse effects, and tolerability, while delivering cardiovascular protection.
Topics: Adrenergic beta-Antagonists; Antihypertensive Agents; Benzopyrans; Carbazoles; Carvedilol; Ethanolamines; Heart Failure; Humans; Hypertension; Labetalol; Nebivolol; Propanolamines; Treatment Outcome
PubMed: 19583633
DOI: 10.1111/j.1751-7176.2009.00140.x -
Journal of Clinical Hypertension... Apr 2006Following a hypertension symposium in Rochester, NY, in October 2005, a roundtable was convened to discuss hypertensive emergencies. Dr. Marvin Moser, Clinical Professor...
Following a hypertension symposium in Rochester, NY, in October 2005, a roundtable was convened to discuss hypertensive emergencies. Dr. Marvin Moser, Clinical Professor of Medicine at the Yale University School of Medicine, New Haven, CT, moderated the session, which included Dr. Joseph L. Izzo, Jr., Professor of Medicine at the State University of New York at Buffalo, Buffalo, NY, and Dr. John Bisognano, Associate Professor of Medicine at the University of Rochester School of Medicine, Rochester, NY.
Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Captopril; Clonidine; Diuretics; Emergencies; Emergency Medical Services; Humans; Hypertension; Labetalol
PubMed: 16596031
DOI: 10.1111/j.1524-6175.2006.05274.x -
American Journal of Translational... 2021To determine the clinical efficacy of aspirin combined with labetalol on gestational hypertension (GH) and its influence on serum pregnancy associated plasma protein-A...
OBJECTIVE
To determine the clinical efficacy of aspirin combined with labetalol on gestational hypertension (GH) and its influence on serum pregnancy associated plasma protein-A (PAPP-A), adiponectin (APN), and high mobility group box-1 (HMGB1).
METHODS
A total of 146 patients with GH admitted to the Zibo Central Hospital between April 2018 and January 2020 were analyzed retrospectively. The control group (Con group, n=71) was treated by labetalol monotherapy, and on this basis, the research group (Res group, n=75) was additionally given aspirin. The following criteria of the 2 groups were evaluated: total effectiveness rate, incidence of adverse reactions, blood pressure-associated indices, coagulation function-associated indices, changes in serum PAPP-A, APN, and HMGB1 levels, adverse maternal and infant outcomes, and neonatal Apgar score.
RESULTS
After therapy, the Res group showed a notably higher total effective rate than the Con group, with no remarkable difference in the incidence of adverse reactions. Additionally, compared to the Con group, the Res group showed notably lower systolic blood pressure (SBP) and diastolic blood pressure (DBP), greatly improved coagulation function, significantly lower levels of serum PAPP-A and HMGB1, and significantly higher level of serum APN. Moreover, the incidence of adverse maternal and infant outcomes in the Res group was much lower than that in the Con group after therapy, and the one- and five-min Apgar scores of neonates in the Res group were both notably higher than those in the Con group after delivery.
CONCLUSION
For patients with GH, aspirin combined with labetalol can effectively control blood pressure, improve coagulation function and clinical efficacy, lower serum PAPP-A and HMGB1, and increase serum APN, and ameliorate maternal and infant outcome.
PubMed: 35035713
DOI: No ID Found -
European Review For Medical and... May 2020To explore the regulatory effect of magnesium sulfate combined with nifedipine and labetalol on disease-related molecules in serum and placenta in the treatment of...
OBJECTIVE
To explore the regulatory effect of magnesium sulfate combined with nifedipine and labetalol on disease-related molecules in serum and placenta in the treatment of preeclampsia.
PATIENTS AND METHODS
Altogether 100 patients with preeclampsia admitted to the Children & Women's Healthcare of Laiwu City were selected. They were divided into control group and experimental group according to different treatment methods. Among them, 51 patients in the control group were treated with magnesium sulfate combined with nifedipine, and 49 patients in the experimental group were treated with labetalol on the basis of the treatment in the control group. The therapeutic effects of the two methods were compared. The levels of the following factors in the two groups were compared: kallikrein expression, pregnancy-associated plasma protein A (PAPP-A), pregnancy-specific β1 glycoprotein (SPI), placental growth factor (PLGF), human placental prolactin (HPL), transforming growth factor β1(TGF-β1), vascular cell adhesion molecule 1 (VCAM-1) and E-selectin in serum and placenta tissues.
RESULTS
After treatment, the blood pressure in the experimental group was lower than that in the control group (p<0.05). The expression of kallikrein in serum and placental tissue of the patients in the experimental group was higher than that of the patients in the control group (p<0.05); PAPP-A level was lower than that in the control group (p<0.05); TGF-β1 level was higher than that in the control group (p<0.05); VCAM-1 and E-selectin were lower than those in the control group (p<0.05), and kallikrein and TGF-β1 in serum and placenta in the non-occurrence group were higher than those in the occurrence group (p<0.05). The serum and placenta PAPP-A, VCAM-1, and E-selectin in the non-occurrence group were lower than those in the occurrence group (p<0.05).
CONCLUSIONS
Magnesium sulfate combined with nifedipine and labetalol has good efficacy in the treatment of preeclampsia. They can promote the expression of endogenous kallikrein, reduce the level of pregnancy-related hypertension predictors, and weaken the infiltration ability of cytotrophoblasts.
Topics: Administration, Oral; Adult; E-Selectin; Female; Humans; Labetalol; Magnesium Sulfate; Nifedipine; Pre-Eclampsia; Pregnancy; Prospective Studies; Transforming Growth Factor beta1; Vascular Cell Adhesion Molecule-1; Young Adult
PubMed: 32432770
DOI: 10.26355/eurrev_202005_21199 -
BMC Veterinary Research Jul 2020To evaluate the effect on arterial blood pressure (ABP) of labetalol infusion as treatment for perioperative non nociceptive acute hypertension in dogs. The clinical...
BACKGROUND
To evaluate the effect on arterial blood pressure (ABP) of labetalol infusion as treatment for perioperative non nociceptive acute hypertension in dogs. The clinical records of dogs receiving intra or postoperative labetalol infusion were retrospectively reviewed. Invasive systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressure and heart rate (HR) before labetalol infusion (T0) and 15, 30, 45 and 60 min (T1, T2, T3 and T4 respectively) after infusion were retrieved. The dose rate of labetalol infusion and use of concurrently administered drugs that could have potentially affected ABP and/or HR were also recorded. ANOVA for repeated measures and Dunnett's multiple comparison test were used to determine the effect of labetalol on ABP and HR. Differences were considered significant when p < 0.05.
RESULTS
A total of 20 dogs met the inclusion criteria, and hypertension was documented after craniotomy (12/20), adrenalectomy (4/20) and other procedures (4/20). Five dogs received labetalol intraoperatively, 14 postoperatively, and 1 during the surgical procedure and recovery. Median infusion duration and rate were 463 (60-2120) minutes and 1.1 (0.2-3.4) mg/kg/h respectively. Median loading dose was 0.2 (0.2-0.4) mg/kg. Labetalol produced a significant decrease in SAP and DAP at all time points compared to T0 (p < 0.05), while the effect was not significant at T1 for MAP (p = 0.0519). Median maximum MAP decrease was 31 (20-90) mmHg. Heart rate did not increase significantly during treatment (p = 0.2454). Acepromazine given before or during labetalol treatment did not reduce significantly ABP (p = 0.735).
CONCLUSIONS
Labetalol produced a reliable and titratable decrease in ABP with non significant increase in HR.
Topics: Adrenalectomy; Animals; Antihypertensive Agents; Craniotomy; Dogs; Heart Rate; Hypertension; Intraoperative Complications; Labetalol; Retrospective Studies
PubMed: 32709242
DOI: 10.1186/s12917-020-02475-4 -
Anesthesiology and Pain Medicine Aug 2023Finding the optimal combination of anesthetics to maintain hemodynamic stability during surgery can be challenging. Traditionally, strong opioid analgesics such as...
BACKGROUND
Finding the optimal combination of anesthetics to maintain hemodynamic stability during surgery can be challenging. Traditionally, strong opioid analgesics such as fentanyl and its newer analogs have been used. However, the use of narcotics is associated with certain side effects.
OBJECTIVES
This study compares the effects of labetalol and remifentanil in pain control after bariatric surgery in Hazrat Rasool Akram Hospital.
METHODS
This randomized, double-blind clinical trial was conducted on 48 laparoscopic bariatric surgery patients. The participants were randomly divided into two groups receiving remifentanil or labetalol. Postoperative pain was measured in the recovery unit using the numerical rating scale (NRS). This score was recorded upon entering recovery, and 30 minutes, 60 minutes, and 120 minutes after surgery for each patient. Also, the duration of anesthesia, the duration of the operation, the recovery time, the dose of the administered opioids, the volume of intravenous fluids, and the dose of administered propofol were recorded for each patient. Nausea and vomiting after the operation were also recorded as outcomes.
RESULTS
There were no significant differences between the two groups regarding the mean duration of surgery and anesthesia, dose of the administered anesthetics, recovery period, nausea and vomiting, and the dose of analgesics after the operation. The mean pain intensity during the given period and also the trend of pain intensity changes between the two groups demonstrated no statistically significant differences (P = 0.112). During the operation, 9 subjects (37.5%) in the labetalol group and 16 (66.7%) in the remifentanil group needed more analgesics (rescue drug); in this regard, a significant difference was observed between the two groups (P = 0.043).
CONCLUSIONS
Based on the study's findings, there were no significant differences between labetalol and remifentanil in post and perioperative pain control. However, rescue drugs needed to maintain hemodynamic stability during laparoscopic surgery were significantly lower in patients who received labetalol than remifentanil. Postoperative complications were also comparable between labetalol and remifentanil.
PubMed: 38024005
DOI: 10.5812/aapm-138220 -
Asian Journal of Neurosurgery 2016The application of skull pins in neurosurgical procedures is a highly noxious stimulus that causes hemodynamic changes and a rise in spectral entropy levels. We designed...
Comparison of intravenous labetalol and bupivacaine scalp block on the hemodynamic and entropy changes following skull pin application: A randomized, open label clinical trial.
BACKGROUND
The application of skull pins in neurosurgical procedures is a highly noxious stimulus that causes hemodynamic changes and a rise in spectral entropy levels. We designed a study to compare intravenous (IV) labetalol and bupivacaine scalp block in blunting these changes.
PATIENTS AND METHODS
Sixty-six patients undergoing elective neurosurgical procedures were randomized into two groups, L (labetalol) and B (bupivacaine) of 33 each. After a standard induction sequence using fentanyl, propofol and vecuronium, patients were intubated. Baseline hemodynamic parameters and entropy levels were noted. Five minutes before, application of the pins, group L patients received IV labetalol 0.25 mg/kg and group B patients received scalp block with 30 ml of 0.25% bupivacaine. Following application of the pins, heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and response entropy (RE)/state entropy (SE) were noted at regular time points up to 5 min.
RESULTS
The two groups were comparable with respect to their demographic characteristics. Baseline hemodynamic parameters and entropy levels were also similar. After pinning, the HR, SAP, DAP, MAP, and RE/SE all increased in both groups but were lower in the scalp block group patients. HR increased by 19.8% in group L and by 11% in group B. SAP increased by 11.9% in group L and remained unchanged in group B. DAP increased by 19.7% in group L and by 9.9% in group B, MAP increased by 15.6% in group L and 5% in group B (P < 0.05). No adverse effects were noted.
CONCLUSION
Scalp block with bupivacaine is more effective than IV labetalol in attenuating the rise in hemodynamic parameters and entropy changes following skull pin application.
PubMed: 26889282
DOI: 10.4103/1793-5482.165801 -
Hypertension in Pregnancy Dec 2024Preeclampsia (PE) is a pregnancy disorder that represents a major cause of maternal and perinatal morbidity and mortality. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Preeclampsia (PE) is a pregnancy disorder that represents a major cause of maternal and perinatal morbidity and mortality.
METHODS
This network meta-analysis was registered with PROSPERO. We searched the PubMed, ClinicalTrials.gov. and Embase databases for studies published from inception to the 31 of March 2023. RevMan5.3 software provided by the Cochrane Collaboration was used for direct meta-analysis (DMA) statistical analysis. Funnel maps, network meta-analysis (NMA), the surface under the cumulative ranking curve (SUCRA) to rank the different interventions and publication bias were generated by STATA 17.0 software.
RESULTS
We included eight randomized controlled trials (RCTs) involving a total of 1192 women with PE; two studies were of high quality and six were of moderate quality. Eight interventions were addressed in the NMA. In the DMA, we found that blood pressure in the Ketanserin group were significantly higher than those in the Nicardipine group. NMA showed that blood pressure in the Dihydralazine group was significantly higher than that in the Methyldopa, Labetalol, Nicardipine and Diltiazem groups. And the blood pressure in the Labetalol group was significantly lower than that in the Nicardipine group. SUCRA values showed that Diltiazem was more effective in lowering blood pressure than other drugs looked at in this study.
CONCLUSION
According to the eight RCTs included in this study, Diltiazem was the most effective in reducing blood pressure in PE patients; Labetalol and Nicardipine also had good effects. Diltiazem is preferred for the treatment of patients with severe PE and high blood pressure.
Topics: Pregnancy; Female; Humans; Antihypertensive Agents; Labetalol; Pre-Eclampsia; Diltiazem; Nicardipine; Network Meta-Analysis
PubMed: 38488570
DOI: 10.1080/10641955.2024.2329068 -
World Journal of Plastic Surgery Jan 2015Rhinoplasty is one of the most common surgeries of the plastic surgery and as well as ear, throat and nose. Intra-operative bleeding during surgery is one of the most...
BACKGROUND
Rhinoplasty is one of the most common surgeries of the plastic surgery and as well as ear, throat and nose. Intra-operative bleeding during surgery is one of the most important factors that may impair the surgeon's job. Providing a clean blood-free surgical filed makes the operation faster, easier and with a better quality. One way to achieve this goal is to induce hypotension. This study aimed to compare the impacts and outcomes of administration of labetalol or nitroglycerin for this purpose.
METHODS
In this randomized clinical trial, 60 ASA I and ASA II patients who were referred for rhinoplasty were enrolled. Patients were randomly assigned to two groups. Labetalol was given to the first and nitroglycerin to the second group of patients. Blood pressure and the amount of intra-operative bleeding during surgery and surgeon satisfaction were measured.
RESULTS
The average age of patients was 25.9±7.52 years. The average amount of bleeding among all patients was 117.87±324.86 ml, and the average quality of the surgical site was 1.65±4.48, considering all patients. The average quality and average surgical site bleeding between the two groups was not significant.
CONCLUSION
There was a little difference between labetalol and nitroglycerine on the effect of intraoperative blood loss and surgical field quality in rhinoplasty surgery.
PubMed: 25606478
DOI: No ID Found -
The Journal of International Medical... Nov 2023Current evidence supporting the use of continuous intravenous labetalol for blood pressure (BP) control in neurosurgical patients is limited. This study aims to assess...
OBJECTIVES
Current evidence supporting the use of continuous intravenous labetalol for blood pressure (BP) control in neurosurgical patients is limited. This study aims to assess the efficacy and safety of labetalol in neurosurgical patients and identify potential contributing factors to these outcomes.
METHODS
We retrospectively reviewed the medical records of neurosurgical patients who received continuous labetalol infusion for BP control. Efficacy was assessed based on the time needed to achieve the target BP (systolic BP ≤ 140 mmHg or diastolic BP ≤ 90 mmHg). Safety was assessed according to adverse events that occurred during labetalol administration. Factors associated with efficacy and safety were analyzed using a logistic regression model.
RESULTS
Among 79 patients enrolled in this study, 47 (59.49%) achieved the target BP within 1 hour (early response). No factors were significantly associated with an early response. Hypotension was observed in 11 patients (13.9%), and bradycardia was observed in 8 patients (10.1%). Hypotension was significantly associated with patient age and motor impairment, while bradycardia was significantly associated with diabetes mellitus.
CONCLUSION
The efficacy and safety profiles of labetalol infusion suggest this treatment as a promising option for BP control in neurosurgical patients.
Topics: Humans; Blood Pressure; Labetalol; Bradycardia; Retrospective Studies; Hypotension
PubMed: 37987639
DOI: 10.1177/03000605231212316