A Future of Beta Blockers “Plus” to Treat Hypertension

zkt

Member
I once told a resident that I could Rx BP meds as well as any resident out here (at the local VA/med school). That seemed to enrage the young man quite a bit, so much so that our voices brought the attending into the consult room who calmed us down. It pissed him off so much to even consider that a patient could possibly know as much as he about a specific medical thing that he simply couldnt deal with it in an adult to adult manner. Admitably I have never been one to run from a just fight and finshed kicking his ass when the conversation turned to pulmonary function and I asked him if a rarely used drug was available. He had no clue and had to call the attending back in the room to explain it to him.
LOL.
What he didnt know is that I had studied earlier editions of the same textbooks as he for about the same length of time and was progressing into studying specific areas in clinicial studies.
I have the utmost respect for anyone who completes med school not to mention residency because its not for the stupid and lazy. But it does seem to turn some into assholes, altho one might argue that it only accentuates an innate ability. Now this is invaringly true among surgical residents.
But I digress...



Residency attitude = the chip on the shoulder caused by having to be both inexperienced and work in a hospital full of piranha. It is my experience (I completed two hospital-based residencies and spent many nights in the ED, 3 months doing GA in the OR and rotated through many departments) that bed-side skills get better in private practice.

My comment about patients not suing doctors they like is not my idea - father-in-law in a medical malpractice defense attorney in NYC with 40 years experience - that's what he says.
 
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Dr JIM

Member
Oh yea the freebies come with a hefty price tag, MY TIME, away from patients (or Meso, lol)

I accept "samples" with one proviso, "tell them I'm busy at the moment, yet I'm happy to review their literature and try whatever samples they may have, just place them in my office".

Nonetheless many reps require a private discussion to "review their literature" in exchange for "free samples".

Hmm that sounds like a quid-pro-quo to me which is unethical IMO sir!

Actually my staff being familiar with my biases tells them "Dr Jim won't be comfortable doing it that way sir".

To which the majority are willing to comply with my earlier request, knowing if I don't try their drug as a sample I'm very unlikely to prescribe it, got that right!

Finally exclusive of samples (which are the property of my poorly funded patients) I do not accept any "freebies" pens, pocket lights, vacations ect, whatsoever.

Jim
 

Michael Scally MD

Doctor of Medicine
Dispute Flares Inside FDA Over Safety of Popular Blood-Pressure Drugs
Dispute Flares Inside FDA Over Safety of Popular Blood-Pressure Drugs - WSJ.com

The top-selling class of blood-pressure drugs is under attack from an unusual source: a senior regulator at the Food and Drug Administration.

Bucking his bosses, Thomas A. Marciniak is seeking stronger warnings about the drugs known as angiotensin receptor blockers, or ARBs, according to internal documents reviewed by The Wall Street Journal.

The drugs, which are taken by millions of people and generated $7.6 billion in U.S. sales in 2012, may be linked to higher cancer rates, Dr. Marciniak argues, a view shared by some outside doctors. Top FDA officials say evidence doesn't support a link.
 

Dr JIM

Member
Damn DOC I love the way you ensure I'm up to date on the relevant literature.

Hmm, looks like this was a meta-analysis, if so the `primary "outcome factor"s are those variables excluded or included by the authors to prove or disprove a particular theory, if one was selected.

Personally, the ARB's have been a godsend since the sides are few, they are well tolerated and they are effective in many patients whom remained intolerant to BP mgt in spite of being on 2-3 drugs.

Nonetheless since they are can be expensive, I use them as a second line antihypertensive, behind diuretics and ACE inhibitors. Additionally for those with limited resources, especially if with BPH is problematic, a low dose Alpha Blocker remains a more viable option.

jim
 

zkt

Member
Differential effects of nebivolol and metoprolo... [Hypertension. 2012] - PubMed - NCBI

"In summary, treatment with metoprolol decreased insulin sensitivity and increased oxidative stress and the antifibrinolytic plasminogen activator inhibitor 1 in patients with metabolic syndrome, whereas nebivolol lacked detrimental metabolic effects."

Differential effects of nebivolol versus metopr... [Hypertension. 2013] - PubMed - NCBI


In young healthy humans, sympathetic vasoconstriction is markedly blunted during exercise to optimize blood flow to the metabolically active muscle. This phenomenon known as functional sympatholysis is impaired in hypertensive humans and rats by angiotensin II-dependent mechanisms, involving oxidative stress and inactivation of nitric oxide (NO). Nebivolol is a ?1-adrenergic receptor blocker that has NO-dependent vasodilatory and antioxidant properties. We therefore asked whether nebivolol would restore functional sympatholysis in hypertensive humans. In 21 subjects with stage 1 hypertension, we measured muscle oxygenation and forearm blood flow responses to reflex increases in sympathetic nerve activity evoked by lower body negative pressure at rest, and during rhythmic handgrip exercise at baseline, after 12 weeks of nebivolol (5-20 mg/d) or metoprolol (100-300 mg/d), using a double-blind crossover design. We found that nebivolol had no effect on lower body negative pressure-induced decreases in oxygenation and forearm blood flow in resting forearm (from -29±5% to -30±5% and from -29±3% to -29±3%, respectively; P=NS). However, nebivolol attenuated the lower body negative pressure-induced reduction in oxygenation and forearm blood flow in exercising forearm (from -14±4% to -1±5% and from -15±2% to -6±2%, respectively; both P<0.05). This effect of nebivolol on oxygenation and forearm blood flow in exercising forearm was not observed with metoprolol in the same subjects, despite a similar reduction in blood pressure. Nebivolol had no effect on sympathetic nerve activity at rest or during handgrip, suggesting a direct effect on vascular function. Thus, our data demonstrate that nebivolol restored functional sympatholysis in hypertensive humans by a mechanism that does not involve ?1-adrenergic receptors. Clinical Trial Registration- URL: Home - ClinicalTrials.gov. Unique identifier: NCT01502787.
 

zkt

Member
Since starting Nebivolol (5mg/d) a month ago, stopped HCTZ 25mg/d, verapamil 360mg/d, terrazosin 5mg/d and metroprolol 100mg/d. Also went from medrol 8mg/d to HC 20 mg/d which cetainly had something to do with it. I`m sold on it. :)
 

BBC3

Member
I was going to ask and then say the last two posts. I first started out with some metaprolol as samples and prescribed. Maybe I went thru a bottle a year when I got under a lot of pressure. Lately doc have been giving me Bystolic samples. IS THIS NEVIVOLOL?? Cause my post was going to be what exactly IS Bystolic.?? Alls I understand is it has a longer active life compared to metaprolol (am I spelling that right?) ... I also understood that perhaps metaprolol stays as beta1 specifically, whereas Bystolic becomes Beta1 & Beta2 active once the dose builds up a bit with the half life... Is this correct? And what does it mean to me..?:)

Since starting Nebivolol (5mg/d) a month ago, stopped HCTZ 25mg/d, verapamil 360mg/d, terrazosin 5mg/d and metroprolol 100mg/d. Also went from medrol 8mg/d to HC 20 mg/d which cetainly had something to do with it. I`m sold on it. :)
 

zkt

Member
Bystolic is a brand name for NEBVOLOL. Beta 1 receptors are found in the heart muscle and B2 in the bronchial muscles among other places.
Here:
Beta adrenergic receptors | CME at Pharmacology Corner
Nebivolol might not be as selective as first thought. But 5mg/d doesnt cause bronchail constriction in me. A higher dose might tho.


I was going to ask and then say the last two posts. I first started out with some metaprolol as samples and prescribed. Maybe I went thru a bottle a year when I got under a lot of pressure. Lately doc have been giving me Bystolic samples. IS THIS NEVIVOLOL?? Cause my post was going to be what exactly IS Bystolic.?? Alls I understand is it has a longer active life compared to metaprolol (am I spelling that right?) ... I also understood that perhaps metaprolol stays as beta1 specifically, whereas Bystolic becomes Beta1 & Beta2 active once the dose builds up a bit with the half life... Is this correct? And what does it mean to me..?:)
 

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