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Pre-injury beta blocker use does not affect the hyperdynamic response in older trauma patients.

Evans DC, Khoo KM, Radulescu A, Cook CH, Gerlach AT, Papadimos TJ, Steinberg SM, Stawicki SP, Eiferman DS - J Emerg Trauma Shock (2014)

Bottom Line: Our analysis demonstrated no effect on systolic and diastolic blood pressures from beta-blocker, ACE-I/ARB, calcium channel blocker, and amiodarone use.The triple therapy (combined beta-blocker, calcium channel blocker, and ACE-I/ARB) patient group had significantly lower heart rate than the no cardiac medication group.Pre-injury use of cardiac medication lowered heart rate in the triple-agent group (beta-blocker, calcium channel blocker, and ACEi/ARB) when compared the no cardiac medication group.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, The Ohio State University, Columbus, Ohio, USA.

ABSTRACT

Purpose: Trauma dogma dictates that the physiologic response to injury is blunted by beta-blockers and other cardiac medications. We sought to determine how the pre-injury cardiac medication profile influences admission physiology and post-injury outcomes.

Materials and methods: Trauma patients older than 45 evaluated at our center were retrospectively studied. Pre-injury medication profiles were evaluated for angiotensin-converting enzyme inhibitors / angiotensin receptor blockers (ACE-I/ARB), beta-blockers, calcium channel blockers, amiodarone, or a combination of the above mentioned agents. Multivariable logistic regression or linear regression analyses were used to identify relationships between pre-injury medications, vital signs on presentation, post-injury complications, length of hospital stay, and mortality.

Results: Records of 645 patients were reviewed (mean age 62.9 years, Injury Severity Score >10, 23%). Our analysis demonstrated no effect on systolic and diastolic blood pressures from beta-blocker, ACE-I/ARB, calcium channel blocker, and amiodarone use. The triple therapy (combined beta-blocker, calcium channel blocker, and ACE-I/ARB) patient group had significantly lower heart rate than the no cardiac medication group. No other groups were statistically different for heart rate, systolic, and diastolic blood pressure.

Conclusions: Pre-injury use of cardiac medication lowered heart rate in the triple-agent group (beta-blocker, calcium channel blocker, and ACEi/ARB) when compared the no cardiac medication group. While most combinations of cardiac medications do not blunt the hyperdynamic response in trauma cases, patients on combined beta-blocker, calcium channel blocker, and ACE-I/ARB therapy had higher mortality and more in-hospital complications despite only mild attenuation of the hyperdynamic response.

No MeSH data available.


Related in: MedlinePlus

Initial heart rate on admission by cardiac medication Mean and the 95% CI, beta blocker (BB), angiotensin converting enzyme inhibitor/angiotensin II receptor blocker (ACEi), calcium channel blocker (CCB)
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Figure 1: Initial heart rate on admission by cardiac medication Mean and the 95% CI, beta blocker (BB), angiotensin converting enzyme inhibitor/angiotensin II receptor blocker (ACEi), calcium channel blocker (CCB)

Mentions: The heart rate was found to be significantly lower in patients taking the three drug combination of beta-blocker, ACE-I/ARB, and calcium channel blocker medications concurrently [Table 2, Figure 1]. Additionally, patients on beta-blocker and calcium channel blockers tended to have a lower heart rate, despite lacking statistical significance. For all the other medication groups, there were no significant differences in heart rate when compared to the non-medicated patients. Blood pressure (both systolic and diastolic) on arrival showed no significant variability between medication groups [all 95% CI overlapped, Table 2, Figure 2].


Pre-injury beta blocker use does not affect the hyperdynamic response in older trauma patients.

Evans DC, Khoo KM, Radulescu A, Cook CH, Gerlach AT, Papadimos TJ, Steinberg SM, Stawicki SP, Eiferman DS - J Emerg Trauma Shock (2014)

Initial heart rate on admission by cardiac medication Mean and the 95% CI, beta blocker (BB), angiotensin converting enzyme inhibitor/angiotensin II receptor blocker (ACEi), calcium channel blocker (CCB)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231268&req=5

Figure 1: Initial heart rate on admission by cardiac medication Mean and the 95% CI, beta blocker (BB), angiotensin converting enzyme inhibitor/angiotensin II receptor blocker (ACEi), calcium channel blocker (CCB)
Mentions: The heart rate was found to be significantly lower in patients taking the three drug combination of beta-blocker, ACE-I/ARB, and calcium channel blocker medications concurrently [Table 2, Figure 1]. Additionally, patients on beta-blocker and calcium channel blockers tended to have a lower heart rate, despite lacking statistical significance. For all the other medication groups, there were no significant differences in heart rate when compared to the non-medicated patients. Blood pressure (both systolic and diastolic) on arrival showed no significant variability between medication groups [all 95% CI overlapped, Table 2, Figure 2].

Bottom Line: Our analysis demonstrated no effect on systolic and diastolic blood pressures from beta-blocker, ACE-I/ARB, calcium channel blocker, and amiodarone use.The triple therapy (combined beta-blocker, calcium channel blocker, and ACE-I/ARB) patient group had significantly lower heart rate than the no cardiac medication group.Pre-injury use of cardiac medication lowered heart rate in the triple-agent group (beta-blocker, calcium channel blocker, and ACEi/ARB) when compared the no cardiac medication group.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, The Ohio State University, Columbus, Ohio, USA.

ABSTRACT

Purpose: Trauma dogma dictates that the physiologic response to injury is blunted by beta-blockers and other cardiac medications. We sought to determine how the pre-injury cardiac medication profile influences admission physiology and post-injury outcomes.

Materials and methods: Trauma patients older than 45 evaluated at our center were retrospectively studied. Pre-injury medication profiles were evaluated for angiotensin-converting enzyme inhibitors / angiotensin receptor blockers (ACE-I/ARB), beta-blockers, calcium channel blockers, amiodarone, or a combination of the above mentioned agents. Multivariable logistic regression or linear regression analyses were used to identify relationships between pre-injury medications, vital signs on presentation, post-injury complications, length of hospital stay, and mortality.

Results: Records of 645 patients were reviewed (mean age 62.9 years, Injury Severity Score >10, 23%). Our analysis demonstrated no effect on systolic and diastolic blood pressures from beta-blocker, ACE-I/ARB, calcium channel blocker, and amiodarone use. The triple therapy (combined beta-blocker, calcium channel blocker, and ACE-I/ARB) patient group had significantly lower heart rate than the no cardiac medication group. No other groups were statistically different for heart rate, systolic, and diastolic blood pressure.

Conclusions: Pre-injury use of cardiac medication lowered heart rate in the triple-agent group (beta-blocker, calcium channel blocker, and ACEi/ARB) when compared the no cardiac medication group. While most combinations of cardiac medications do not blunt the hyperdynamic response in trauma cases, patients on combined beta-blocker, calcium channel blocker, and ACE-I/ARB therapy had higher mortality and more in-hospital complications despite only mild attenuation of the hyperdynamic response.

No MeSH data available.


Related in: MedlinePlus