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Potential risk of β-blockade withdrawal in congestive heart failure due to abrupt autonomic changes
- Source :
- International Journal of Cardiology. 68:171-177
- Publication Year :
- 1999
- Publisher :
- Elsevier BV, 1999.
-
Abstract
- β-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 β 1 -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 β-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 β-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 β-blockade group. Heart rate variability indicates an elevated vagal tone during treatment with metoprolol but β-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 β-blockade medication in these patients.
Details
- ISSN :
- 01675273
- Volume :
- 68
- Database :
- OpenAIRE
- Journal :
- International Journal of Cardiology
- Accession number :
- edsair.doi...........e69e286aa74c6ccaadabd9dbcc32962c