Beta-blocker therapy: identification and management of side effects

Article Abstract:

Drugs called beta-blockers are commonly prescribed to treat cardiovascular (heart and blood vessel) disorders. These drugs have replaced diuretics as the drugs of choice for treating high blood pressure. However, beta-blockers have side effects that may reduce the quality of the patient's life. This may cause the patient to stop taking the drug or to not take the medication as prescribed. Seventy patients with high blood pressure participated in a study designed to evaluate the extent to which the side effects of beta-blockers affect the quality of life and the amount of medication used. Fifty-one patients were given an exercise plan to follow and were treated with diltiazem (17 patients), propranolol (15 patients), or a placebo (19 patients). Another 19 patients who had been receiving beta-blocker treatment for an average of two and a half years were also evaluated. Frequently reported side effects included difficulty falling asleep at night, vivid and colorful dreams, lack of energy, reduced interest in sex, shortness of breath, vision problems, difficulty thinking clearly and remembering things, altered bowel habits, and depression. Although symptoms were common among all groups, there was variation in the frequency of symptoms reported by patients who exercised and received propranolol, and those who received a beta-blocker only. Some possible explanations for these differences are discussed. The patients were able to control some of the side effects by planning activity and rest periods, making lists to help remember things, thinking before acting, and altering their diet. For other side effects, patients reported that they ignored or suffered through them. Only four of the patients reported that they reduced their medication. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Adrenergic beta blockers, Adrenergic beta-antagonists, Propranolol hydrochloride, Propranolol, Diltiazem

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Atrial natriuretic peptide: a hormone with implications for clinical practice

Article Abstract:

The heart, specifically its upper chambers, or atria, has recently been found to function like an endocrine organ (a ductless gland which secretes a product into the blood system directly). In 1981 it was discovered that the heart produced a small peptide (a molecule composed of a short chain of 28 amino acids), atrial natriuretic peptide (ANP), which is active in causing the excretion by the kidney of sodium (natriuresis) and accompanying large quantities of water (diuresis). Receptors for ANP (molecules on the cell surface that are stimulated by the hormone) have been found on cells of the vascular system, kidney, adrenal gland, lung and brain. ANP appears to link heart, brain, adrenals, kidneys and blood vessels into a physiologic control mechanism for maintaining proper blood volume and pressure. Disruptions of normal function of this dynamic system can lead to pathologic conditions, including fluid retention, elevated cardiac filling rates, raised blood pressure, congestive heart failure, and increased heart rate (paroxysmal tachycardia, atrial fibrillation), disease of the heart valves, destruction of the tissue of the heart (cardiomyopathies), diseases of the heart vessels (coronary heart disease), and chronic kidney failure. Although understanding of the ANP system remains incomplete, knowledge of the system has reached a level such that the function of the system is now clinically relevant. Physicians and nurses must keep abreast of research regarding this important physiologic system and its impact on clinical treatment and diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Heart

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Atrial natriuretic peptide: a new cardiac hormone

Article Abstract:

Specialized cells in the heart secrete the hormone atrial natriuretic peptide (ANP). The number of specialized cells vary by their location, with more secreting cells found in the heart's right atrial chamber. The cell number is also dependent on the amount of salt and water in the body. Specialized cells are stimulated to release ANP when the walls of the atrium are stretched or pressure is created as blood fills the atrium. The release of ANP increases as the atrium is stretched. ANP regulates the amount of circulating fluid by increasing the excretion of salt in the urine or by inhibiting other fluid regulating hormones produced in the kidneys. It also lowers blood pressure by relaxing smooth muscle that lines the inside of blood vessels. The pressure inside the atrium can be altered by a change in position, exercise, drugs, heart disease, abnormal heart rhythms, kidney failure, and conditions affecting circulating blood volume such as salty diet, pregnancy, or congestive heart failure. New technologies allow human ANP to be produced in the laboratory. Although the therapeutic effects of ANP in patients with congestive heart failure are inconclusive, there are many potential therapeutic uses for ANP. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cardiac output, Control

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