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Strategy for identifying an efficient dosage of beta-blocker for elderly patients with myocardial ischemia and

João Batista Serro-Azul1, Mauricio Wajngarten, Amit Nussbacher

  • 1Instituto do Coração, Hospital das Clínicas, FMUSP, São Paulo, SP, Brazil. serro@uol.com.br

Arquivos Brasileiros De Cardiologia
|July 17, 2004
PubMed

Insights

Titrating propranolol (a beta-blocker) to reduce heart rate by 15% safely improves exercise tolerance and reduces myocardial ischemia in elderly patients with coronary heart disease.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Elderly patients with coronary heart disease often experience myocardial ischemia.
  • Beta-blockers are commonly used, but optimal dosing strategies for this population require assessment.

Purpose of the Study:

  • To evaluate a propranolol titration strategy for reducing myocardial ischemia in elderly individuals.
  • To determine if a 15% heart rate reduction during a 50 W exercise load is an effective target.

Main Methods:

  • 14 elderly men with stable coronary heart disease underwent weekly exercise tests.
  • Propranolol dosage was titrated to achieve a 15% heart rate reduction at a 50 W load.
  • Cardiac scintigraphy was performed at rest and during exercise before and after treatment.

Main Results:

  • Propranolol improved exercise duration and abolished ST segment changes in 57% of patients.
  • Heart rate reduction was consistent at rest and during exercise.
  • Ventricular function was preserved at rest; ejection fraction increased during maximum exercise.

Conclusions:

  • The 15% heart rate reduction target via propranolol titration is a safe and effective strategy for elderly patients.
  • This approach reduces myocardial ischemia and enhances exercise tolerance without compromising ventricular performance.
Abstract

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