After my heart attack and fitting of two stents, I was given the medication in accordance with the valid protocol, which includes the daily beta blocker (2.5 mg bisoprolol). I have actively engaged in sports for the last 20 years and am otherwise in excellent physical condition and for years, before and after the attack, my resting heart frequency has been about 50 and my resting blood pressure about 110/60. Needless to say, with the beta blocker both of these parameters are lower now.
When I asked my cardiologist what is the purpose of taking the beta blocker in my case, she explained that, even though I do not need it in order to lower my blood pressure, it is still beneficial because of its antiaggregant properties.
I have since tried to confirm this in cardiology literature, but have so far not managed to find any information to that effect. Could someone please help and direct me to a reliable source of information that describes the antiaggregant properties of beta blockers?
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Jerry_D
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I had OHS to replace genetic Aortic Valve condition and underwent nearly6 years of monitoring prior to 'intervention' being deemed necessary. During this time I endured two or three different medication regimes involving 'thinners' and BP management.
My understanding is that the two are very different and that BP meds (of the beta-blocker variety - I take Bisoprolol) are definitely not prescribed for any anti-aggregant properties. As a tissue valve recipient I did ask my surgeon whether I needed to take beta-blocker for life or just as a precaution to protect new valve and pipework whilst they bedded in and the answer was that, although not conclusively proved he believed that they reduce risk of stenosis in valve area.
The analogy used to describe function of beta-blockers as that they a little bit like a rev-limiter on a car engine and so protect your heart muscles from excessive strain - a good thing if your event caused residual heart muscle damage which is quite likely(I think) if you required stents.
I found the BHF guides a good starting point for furthering my understanding as well as the post-op re-hap nurse. search for this : Medicines for my heart - Booklet - BHF
Thanks Steve. I'll definitely check out the BHF booklet. I still wonder - when your surgeon said that they reduce risk of stenosis in valve area - how exactly do they achieve that? What is the mechanism? And if the engine needs to have its revs limited, how come then that the physical activity is in fact recommended? As part of my recovery, the hospital arranged for 10 one-hour sessions of pretty strenuous exercise for myself and other similar patients a week after my procedure.
I'm not a doctor, nor a surgeon. one of the dilemma's faced by people facing elective heart surgery is the fact that exercise of one's cardiovascular system is beneficial to not only your overall health but also the very organ that is struggling to cope, and gradually deteriorating, but may well accelerate deterioration/trigger an event.
The surgeon was either unable or unwilling to go into detail as to why he believed beta-blockers to help manage stenosis- by this time we had got to know each other a little - but was clear that this was his personal opinion rather than a clinically proven fact. I trusted him and still take low dosage |Bisoprolol. since OHS I have followed C25K program and am able to run for up to an hour, Pulse hitting peaking in 180s / 6min kms. (I'm 59 y-o, 5'9", averge weight) but stays mainly 140-150. resting rate sems to have settled around low 60's which is ~10-20 lower than pre-op. My BP is now spot on 120/80 whilst pre-op it ranged between 140-180/ 90-110.
Your post suggests that you have suffered a heart attack and so your situation is very different to mine (pre-op scans etc showed very little blockage in my cardiac arteries and so my heart muscle (fortunately) remained healthy) and I don't have pre-op benchmark due need to manage risk of aortic dissection that accompanies the duff valve I had (incidentally by use of ACE inhibitors rather than BB) . As heartifact says, beta-blocker seems to only be noticeable when in high effort zone when (I'm guessing) your heart muscle needs maximum o2. Again, I'm guessing, but if pareto applies and BB limits flow (and so O2) by 20% (I think it not be so dramatic) heart still getting 80% - enough to support a fair level of exercise.
You're clearly a very fit chap and I imagine used to 'listening' to your body - my top tip would be to continue doing just that and adjust training/exercise load accordingly - exactly the same as recovering from muscular trauma ('cos that is kind owhat has happened), keep yourself informed so that conversations with cardios/medics can be as informative as possible - personally I would need very strong motivation to go against the cardio or surgeon's advice (both of whose opinion/advice I think trumps that of the GP)
Hi Steve. Not at all a ramble. Most helpful in fact! Thank you for that. I do my almost daily 7-8 km nordic walk at 10 min km and never get above 110 bpm (mean value being in the low 90s). Asleep at night my Apple watch measures lows sometimes dropping to 35. My cardiologist said that's fine.
I was told something similar. But how come then that the physical activity is in fact recommended? As part of my recovery, the hospital arranged for 10 one-hour sessions of pretty strenuous exercise for myself and other similar patients.
It helps, thanks a lot! It does coincide with my own experience and understanding. However, I'm curious about the scientific details. I would like to be able to evaluate all the known aspects and hopefully even stop the beta blockers if I can properly weigh all the relevant pros and cons. Trying to get that from five different cardiologists in three different countries hasn't got me very far 🙂. The nerd in me finds it difficult to accept "it's good for you" or "it's the protocol" as an answer.
Will do of course. I too seem to have become intolerant. In agreement with my cardiologist I tried changing to other types (e.g. metoprolol and nebivolol) but the issues remained. That's why I'm also considering to get off the beta blockers.
can I ask, when you became intolerant, what were your symptoms? My husband would love to come off metoprolol as his BP has never been high and his resting heart rate is in the 40s. He seems to get lots of weird side effects but every time he brings it up with his GP he is reluctant to change anything.
Apologies for the delay in answering. Two things basically: extremely low heart frequency in sleep and feeling tired throughout the day. There is also something else, but that is not necessarily related: my thermoregulation misfires. Independently of the ambient temperature and clothing I suddenly get cold. I now keep a steady temperature of 28-30 C at home and at least once a day I suddenly feel cold and need to crank up the AC or dress up or both. This lasts sometimes 10 minutes and sometimes two hours and is sometimes accompanied by a strange feeling similar to nausea and/or mild chest pain. I've done a large number of tests and been examined by many specialists and they have not found an explanation. But, as I said, it probably has nothing to do with the beta blocker.
My husband has a low heart rate and gets tired during the day and has to go for a nap. He too feels cold. He gets nauseous at times but it’s almost like his blood sugar drops because if he has a cereal bar he feels better. He also gets a lot of bloating, which has now developed to a loud hiccup/burp. His G.P. doesn’t seem willing to try changing any medication so he lives with it. Reading other people’s comments on this forum it sounds like some have better luck with their doctor.
Beta blockers such as bisoprolol are drugs that block the action of adrenaline and noradrenaline specifically on the heart muscle. In addition to lowering BP, they have a two-fold effect on the heart itself - they reduce both the rate at which the heart beats and also the force of its contractions so reducing the hearts capacity to work. The overall effect is to limit the amount of work that the heart does and therefore limit its demand for oxygen. Clinically, this reduces the risk of angina but could also be at least partly responsible for the tiredness that is frequently reported as a side effect. This was all well known many years ago when I did my undergrad studies in pharmacology and I can’t recall mention of anti-aggregant properties. Platelet anti-aggregant drugs such as aspirin, clopidogrel an ticagrelor are normally prescribed along with cardio-specific beta blockers to prevent heart attacks.
You mentioned protocol.... arghh, the dreaded P word, I hate it. I ran across that after my elective bypass when I was given a loop diuretic despite having advised them I can't take either loop or thiazide diuretics. Thankfuly after finding out what was making me so unwell and refusing to take any more, a doctor cut across protocol and gave me a potassium-sparing diuretic intravenously and I recovered inside three hours.
Basically you are right to question your medication. After adjustments agreed with health professionals I now have what for me is the ideal cocktail. After my heart attack I was initially put on 3.75mg Bisoprolol which gave me awful feelings of impending doom. My GP was not very sympathetic, but after a few strong words the dose was reduced to 2.5mg and after consultation with the practice pharmacist, who was far more reasonable, it was lowered to 1.25mg. Even on this low dose I definitely feel its effects when I exercise, but thankfully I'm a hill walker not a runner, so it's of little consequence. I could stop taking it, but retain it as part of my medication for the benefits it provides.
If you feel 2.5mg is too much, it might be worth consulting your cardiologist and trying a lower dose. We are all different and medication needs to be tailored individually. Unfortunately some in the NHS haven't grasped this fact.
I was taken off beta blockers as after recovery was slowing my heart beat below 40 which was too low for me making me very weak and out of breath just walking a short distance. I came off them and feel so much better can walk about a mile now and at a reasonable pace ,it was because my normal resting rate was low. If you have high blood pressure they should give you a different tablet fir that
I haven't read the thread in full, but a skim through suggests that your question hasn't yet been addressed.
There is a suggestion that Beta Blockers, especially non heart-specific ones such as propranolol, may possibly have some anti platelet effect, but the jury is apparently still out. The only reference I have is a paper from 2014:
I had a quick search and found this paper which indicates that beta blockers have Anti-aggregant effects and that the degree of the effect differs between different beta blockers.
Many thanks! Both this paper and the one suggested by Engineer46 also contain other references to more research on the subject. I'll go through them with great interest.
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