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Beta-blockers and dreams

Jonathan A Goldner
INTRODUCTION: Metoprolol is a widely used beta-adrenergic blocker that is commonly prescribed for a variety of cardiovascular syndromes and conditions. While central nervous system adverse effects have been well-described with most beta-blockers (especially lipophilic agents such as propranolol), visual hallucinations have been only rarely described with metoprolol. CASE PRESENTATIONS: Case 1 was an 84-year-old Caucasian woman with a history of hypertension and osteoarthritis, who suffered from visual hallucinations which she described as people in her bedroom at night...
February 15, 2012: Journal of Medical Case Reports
Mohammed F Abdul-Mohsen
Primary and secondary prevention of cardiovascular diseases (CVD) are markedly overlooked worldwide. The use of these kinds of preventive methods will greatly improve outcome of or even reverse major CVD, especially coronary atherosclerosis. Comprehensive lifestyle changes combined with aggressive medical therapy [lipid lowering agents "statins", antiplatelet agents, beta-blockers and angiotensin-converting enzyme inhibitors] for patients suffering from coronary heart disease significantly reduce all major adverse cardiovascular events (MACE), especially in those with stable coronary artery disease (CAD), even if their coronary lesions are significant...
September 2011: Journal of Family & Community Medicine
Ioanna Eleftheriadou, Costas Tsioufis, Dimitrios Tsiachris, Nicholas Tentolouris, Christodoulos Stefanadis
The majority of individuals with pre-diabetic states eventually appear to develop diabetes mellitus. During the pre-diabetic state, that may last many years, the risk of cardiovascular disease is modestly increased, with impaired glucose tolerance being slightly stronger predictor for future cardiovascular disease than impaired fasting glucose. The role of different antihypertensive drugs in the acceleration or the delay of diabetes onset is controversial. Agents that interrupt the renin-angiotensin system, such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers are likely to be beneficial in the prevention of diabetes, while calcium channel blockers are thought to act metabolically neutral...
November 2011: Current Vascular Pharmacology
John M Cruickshank
The life-time risk of developing HF is about 20% (40% if hypertension present). With increasing longevity in the developed world the burden of HF (hospitalisation) is set to increase over the next 10-20 years. CAD and hypertension are the two main causes of HF; CAD (and obesity) in the case of systolic HF and hypertension in the case of diastolic HF (mainly in the elderly). BB have become the corner-stone (alongside ACE-inhibitors) in the treatment of systolic HF. Bisoprolol, metoprolol and carvedilol (on an ACE-inhibitor background) have reduced all-cause death by 34-5%...
March 2010: Indian Heart Journal
Amir I A Ahmed, Patricia van Mierlo, Paul Jansen
In the Netherlands, the prescription of beta-blockers to patients older than 70 years has increased sharply in recent years. The neuropsychiatric adverse reactions associated with the use of beta-blockers are relatively uncommon and they are mostly seen with poisoning or overdose. We describe an 81-year-old man who developed sleep disorders, nightmares, depression and anxiety as probable adverse effect of low-dose metoprolol (25 mg/day). This case illustrates not only the neuropsychiatric adverse reactions of beta-blockers, but also that diagnosis of these reactions can be easily missed in elderly patients...
November 2010: General Hospital Psychiatry
John A Elefteriades, Emily A Farkas
This paper addresses clinical controversies and uncertainties regarding thoracic aortic aneurysm and its treatment. 1) Estimating true aortic size is confounded by obliquity, asymmetry, and noncorresponding sites: both echocardiography and computed tomography/magnetic resonance imaging are necessary for complete assessment. 2) Epidemiology of thoracic aortic aneurysm. There has been a bona fide increase in incidence of aortic aneurysm making aneurysm disease the 18th most common cause of death. 3) Aortic growth rate...
March 2, 2010: Journal of the American College of Cardiology
A I A Ahmed, P J W B van Mierlo, J A van Waarde, P A F Jansen
A 71-year-old man had had visual hallucinations and vivid dreams for two years after starting to take metoprolol. When metoprolol was replaced by atenolol the patient's symptoms disappeared within five days. Side-effects of beta-blockers on the central nervous system are relatively uncommon. The mechanisms underlying these side-effects are not fully understood. Lipophilic beta-blockers can cross the blood-brain barrier, whereas hydrophilic beta-blockers cannot. Doctors need to be alerted to the varying side-effects of specific beta-blockers...
2010: Tijdschrift Voor Psychiatrie
Jennifer M Perkins, Stephen N Davis
PURPOSE OF REVIEW: Diabetes mellitus is an exploding epidemic costing billions of dollars yearly. Type 2 diabetes mellitus is characterized by insulin resistance and is closely associated with arterial hypertension. Emerging literature has demonstrated that modulation of the renin-angiotensin-aldosterone system by use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers leads to improved insulin sensitivity, glycemic control and possibly prevention of type 2 diabetes mellitus...
April 2008: Current Opinion in Endocrinology, Diabetes, and Obesity
Pilar Mazón-Ramos, Vicente Bertomeu-Martínez, José L Palma-Gámiz, Juan Quiles-Granado, José Guindo-Soldevilla, José R González-Juanatey
During 2006, new evidence supporting the need to adopt a global approach to the treatment of cardiovascular risk in hypertensive patients has been reported. It is increasingly clear that it is not sufficient to aim for optimum blood pressure control, which in any case is not easy to achieve, and that it is essential to treat all cardiovascular risk factors by using drugs with proven benefits, even when those benefits are supplementary to the drug's principal effects. In addition, drugs that could have a detrimental effect or that are, merely, less beneficial should be avoided or kept as a last resort...
February 2007: Revista Española de Cardiología
Susan Simmons Holcomb
Type 2 diabetes mellitus (DM2) has increased 41% in the United States, with an estimated one third undiagnosed and another 41 million with prediabetes. Hypertension affects 20% to 60% of all diabetics, contributing to up to 75% of deaths due to cardiovascular disease. These staggering statistics make it imperative that hypertensive patients who are at risk for DM2 are identified and treated early. Numerous studies have been done involving choice of antihypertensive in established diabetics, and a slowing or halting of the progression in the development of diabetes in these patients has been noticed...
December 2005: Current Hypertension Reports
Lawrence A Leiter, Richard Z Lewanczuk
Rates of type 2 diabetes mellitus are increasing worldwide at an explosive rate. This "epidemic" is largely driven by a concomitant obesity epidemic, which is seen not only in affluent countries, but in industrializing countries as well, concomitant with the rapid change toward Western life-style patterns worldwide. Recent clinical trials such as Heart Outcomes Prevention Evaluation (HOPE), Losartan Intervention for Endpoint reduction (LIFE), and Study of Cognition and Prognosis in the Elderly (SCOPE) have indicated that blocking the renin-angiotensin system (RAS) may reduce the risk of developing type 2 diabetes mellitus...
January 2005: American Journal of Hypertension
André J Scheen
Type 2 diabetes mellitus is becoming a major health problem associated with excess morbidity and mortality. As the prevalence of type 2 diabetes is rapidly increasing, prevention of the disease should be considered as a key objective in the near future. Besides lifestyle changes, various pharmacological treatments have proven their efficacy in placebo-controlled clinical trials, including antidiabetic drugs such as metformin, acarbose and troglitazone, or antiobesity agents such as orlistat. Arterial hypertension, a clinical entity in which insulin resistance is common, is strongly associated with type 2 diabetes and may precede the disease by several years...
2004: Drugs
Chiharu Maebara, Hisakazu Ohtani, Hideyo Sugahara, Kazunori Mine, Chiharu Kubo, Yasufumi Sawada
OBJECTIVE: To report a case of nightmares and sleep disorder associated with improper use of carvedilol, an alpha/beta-blocker, and to model the time course of receptor occupancy in this patient. CASE SUMMARY: A 41-year-old man with panic disorder had been treated with alprazolam 1.2 mg/d (3 times daily), carvedilol 10 mg/d (once in the morning), and etizolam 0.5 mg (for anxiety attack). Although the physical and psychological symptoms gradually improved, he reported nightmares and panic attacks...
November 2002: Annals of Pharmacotherapy
Alexander A Fisher, Michael Davis, Ian Jeffery
OBJECTIVE: To describe a case of delirium associated with use of metoprolol and to analyse 24 such cases including 22 cases reported to Australian Adverse Drug Reaction Advisory Committee and one case previously published (S. Ahmad, Am Fam Physician, 1991;44:1142, 1144). CASE SUMMARY: An 89 year old caucasian man with an acute coronary syndrome who had no psychiatric history and no infections, brain injury, stroke, metabolic nor neoplastic disease developed delirium after two small doses of metoprolol (25 mg)...
March 2002: Cardiovascular Drugs and Therapy
D F Thompson, D R Pierce
OBJECTIVE: To compile and assess the English-language literature on drug-induced nightmares, excluding nightmares secondary to drug withdrawal or drug-associated night terrors. DATA SOURCES: Published articles, letters, case reports, and abstracts in English were identified by MEDLINE (1966-May 1998) searches using the search term nightmares, chemically induced. Additional articles were obtained from bibliographies of retrieved articles. DATA EXTRACTION: All case reports of drug-induced nightmares were evaluated using the Naranjo algorithm for causality...
January 1999: Annals of Pharmacotherapy
G Bengesser
The recent developments of depthpsychology and neurophysiology makes a new orientation and interpretation of dreams necessary. Koella for example describes night-mares of persons taking Beta-blockers. Of course, the great ideas of Freud and Adler should be integrated, not abandoned. Most of all influences of biologic factors on quality of dreams should be discussed.
1995: Wiener Medizinische Wochenschrift
C A Kirk, R Cove-Smith
A double-blind crossover study was performed to compare the incidence of central nervous system (CNS) side effects with atenolol and metoprolol. Eleven women and 6 men who had previously developed such side effects on lipophilic beta-blockers were identified by means of a preliminary questionnaire. A 30-item psychiatric questionnaire was then used to detect changes in psychological status and possible CNS side effects. Discontinuation of the original lipophilic beta-blocker produced a significant improvement in quality of sleep, dreams, concentration, memory, energy and anxiety...
1983: Postgraduate Medical Journal
R V Lewis, P R Jackson, L E Ramsay
We have devised a series of visual analogue scales (VAS) to measure the side-effects prevalent amongst hypertensive patients taking beta-adrenoceptor blockers, and we present the results of a pilot study. These show that the method is suitable for studying side-effects and suggest that patients on beta-adrenoceptor blockers experience a greater incidence of tiredness of the legs, (P = 0.001), cold digits (P = 0.005) and vivid dreaming (P = 0.01) when compared to hypertensive patients not taking beta-adrenoceptor blockers...
September 1984: British Journal of Clinical Pharmacology
E S Paykel, R Fleminger, J P Watson
The psychiatric side effects of the major antihypertensive drugs other than reserpine are reviewed, including centrally acting drugs such as methyldopa and clonidine, peripheral adrenergic drugs such as guanethidine, beta-adrenoceptor blockers such as propranolol, and diuretics. Problems with differential diagnosis and with the interpretation of case reports make assessment of psychiatric side effects difficult. Sedation and sleep disturbances are the most common side effects, occurring with methyldopa, clonidine, and propranolol...
February 1982: Journal of Clinical Psychopharmacology
C Bengtsson, J Lennartsson, O Lindquist, H Noppa, J Sigurdsson
Of 1302 women aged 44-66 years in a population study in Göteborg, Sweden, in 1974-75, who were representative of women of all the ages studied in the area, 165 were taking antihypertensive drugs, mostly beta-blockers and diuretics. The prevalence of sleep disturbances, nightmares, tiredness and melancholia or depression was studied in the total population sample, and a comparison was made between women who were or were not taking antihypertensive drugs. In the entire population sample no significant difference was found between the various age strata studied, although with increasing age there was a trend towards fewer complaints of nightmares, but a larger number of sleep disturbances as a whole...
1980: European Journal of Clinical Pharmacology
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