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[Hemodynamic effects of the cold pressor test in patients with heart failure treated with beta blockers for a long
A V Mattioli1, G Bettelli, C Cappello
1Cattedra di Malattie dell'Apparato Cardiovascolare, Università degli Studi, Modena.
Insights
Beta-blocker therapy may benefit patients with congestive heart failure (CHF) by improving cardiac function. This study found that atenolol attenuated sympathetic response in CHF patients, suggesting a mechanism for improved outcomes.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) is associated with reduced beta-adrenoceptor density and responsiveness.
- Beta-blocker therapy has shown potential to improve clinical outcomes in select CHF patients.
Purpose of the Study:
- To evaluate the sympathetic nervous system response in patients with CHF.
- To assess the hemodynamic effects of the cold pressor test in CHF patients with and without beta-blocker treatment.
Main Methods:
- Hemodynamic parameters (heart rate, blood pressure, cardiac index, etc.) were measured during the cold pressor test.
- The study included 20 participants: 10 with CHF and 10 healthy volunteers, divided into four therapy groups.
- Evaluated modifications in heart rate, mean arterial pressure, and systemic vascular resistance.
Main Results:
- In healthy subjects, the cold pressor test induced expected hemodynamic changes.
- In CHF patients not on beta-blockers, an increased heart rate, elevated systemic vascular resistance, and reduced cardiac index were observed.
- Atenolol treatment attenuated the sympathetic response to the cold pressor test in CHF patients, with a trend towards increased cardiac index.
Conclusions:
- Beta-blocker therapy, specifically with atenolol, appears to modulate sympathetic response in CHF.
- The observed trend of increased cardiac index with atenolol treatment may explain its beneficial effects in selected CHF patients.
Abstract:
In congestive heart failure (CHF) the beta-adrenoceptor density and functional responsiveness is markedly reduced presumably due to endogenous down-regulation. In the last few years evidence has accumulated that betablockers therapy can improve clinical condition in selected patients with CHF. To evaluate sympathetic response in CHF we measured hemodynamic effects of cold pressor test. This study was composed by 20 patients, 10 with CHF of different origin and 10 healthy volunteers. They were divided into 4 groups in relation to therapy. We evaluated the modification of the following hemodynamic parameters during cold pressor test: heart rate, mean arterial pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, right atrial pressure, cardiac index, systemic vascular resistance, pulmonary vascular resistance. In normal subjects we observed hemodynamic modification of heart rate, mean arterial pressure and systemic vascular resistance according to many other Authors. In atenolol-treated subjects the sympathetic response is strongly attenuated. Patients with CHF not treated with betablockers showed an increase in heart rate and in systemic vascular resistance and a reduction of cardiac index. Chronic treatment with atenolol did not modify heart rate response to cold pressor test. The mean arterial pressure increased while the systemic vascular resistance did not show any significant modification. We observed a trend to increase of the cardiac index; this could explain the beneficial effect of betablockers therapy in selected patients.