Clinical studiesBeta-blockers as single-agent therapy for hypertension and the risk of mortality among patients with chronic obstructive pulmonary disease
Section snippets
Design and setting
We performed a cohort study using data from the Veterans Affairs (VA)-funded Ambulatory Care Quality Improvement Project (ACQUIP) (11), a randomized trial that tested whether monitoring patients’ self-reported health and providing regular reports to primary care clinicians improved clinical outcomes and patient satisfaction. ACQUIP sought to enroll all patients actively participating in the general internal medicine clinics of seven VA medical centers: Puget Sound Health Care System,
Results
We identified 1966 COPD patients with hypertension (2.5% were women) who had also been treated with a drug from a single antihypertensive medication class. Compared with patients receiving calcium channel blockers (Table 1), those taking beta-blockers were similar with regard to Seattle Index of Comorbidity scores and prevalence of chronic heart failure or diabetes, but were more likely to have cardiac disease (P = 0.02) or a previous diagnosis of acute coronary syndrome (P <0.001). Similar
Discussion
We found that among COPD patients with hypertension, beta-blockers were associated with a reduction in all-cause mortality. The risk reduction appeared similar, although not consistently statistically significant, when an alternative reference group of all other antihypertensive agents was chosen. Because of the high prevalence of ischemic heart disease among these patients, we hypothesize that the apparent benefit of beta-blockers may be related to a reduction in adverse cardiovascular events.
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Cited by (58)
Beta-blocker use in patients with chronic obstructive pulmonary disease: A systematic review: A systematic review of βB in COPD
2023, Trends in Cardiovascular MedicineCitation Excerpt :All-cause mortality was reported in 24 observational studies [7,27-29,31-38,40,42-52]. Mortality was significantly reduced with βB use in 17 studies (range of reported HR 0.38- 0.91), [7,27-29,32-35,38,40,42,43,45,49-52] not affected in five, [31,36,44,46,47] and significantly increased in two (range of reported HR 1.19 – 1.37) (Table 3) [37,48]. Although the results of these studies are conflicting and more studies reported reduction or no change in over-all mortality rather than an increase in mortality with βB use, the higher quality two observational studies reported increase in mortality with βB use, which may indicate that biases have likely confounded studies results.
Diagnostic and Therapeutic Gaps in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease
2019, JACC: Heart FailureCitation Excerpt :Recent epidemiological data suggest that BBs may have beneficial effects in patients with COPD regardless of a concomitant cardiovascular disease, reducing both COPD exacerbations and cardiovascular events. In patients with COPD with co-occurring hypertension who were receiving single-agent antihypertensive therapy, BBs were associated with a decrease in mortality (49). A retrospective cohort study by Short et al. (50) reported a 22% reduction in all-cause mortality with BBs in COPD, irrespective of inhaled therapies.
Who's Afraid of the Big Bad Wolf? Safety of Beta-Blockers in COPD
2019, EClinicalMedicineManagement of chronic obstructive pulmonary disease beyond the lungs
2016, The Lancet Respiratory MedicineCitation Excerpt :However, having COPD still seems to be a reason not to treat patients with these agents, leading to suboptimal cardiovascular management. Results from several observational studies2,18–22 have shown that the use of β blockers is associated with a reduction in overall mortality, exacerbation frequency, and improved outcomes during and after hospital admission for exacerbations. The additional strain of an exacerbation could trigger and expose underlying but previously unknown undiagnosed cardiac dysfunction.16
Role of beta-blockers in patients with COPD: Current perspective
2015, Drug Discovery Today
This study was supported by grants (IIR 99–376, RCD 00–018) from the Department of Veterans Affairs, Health Services Research and Development. Dr. Au is funded by a VA Health Services Research and Development Career Development Award. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.