Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Timolol treatment after myocardial infarction is generally related to a significant reduction in both mortality and reinfarction compared with placebo. Retrospective analyses of the timolol study are performed on subgroups of patients with a high placebo mortality. The present study shows that these patients are target groups for secondary prevention, as they benefit most from timolol treatment after myocardial infarction. In patients 65-75 years of age, the number of cardiac deaths and reinfarctions prevented by timolol treatment is twice as high as that of patients below 65 years of age. Timolol treatment is well tolerated in the older age group and the contraindications for timolol treatment are independent of age up to 75 years. The reduction in mortality and reinfarction is independent of heart size at baseline. However, in patients with cardiomegaly and compensated heart failure on treatment with digitalis and diuretics, timolol treatment may be of special importance because of the very high incidence of cardiac death in this group of patients. In patients with compensated heart failure on treatment with digitalis and diuretics, timolol treatment does not precipitate heart failure. Patients with stable diabetes mellitus basically behave like nondiabetic patients regarding inclusion rate, side effects, and timolol-related reduction in mortality and reinfarction. Decisions concerning secondary prevention with timolol should be independent of preinfarction and postinfarction angina. In conclusion, 70-80% of all the patients below 75 years of age surviving myocardial infarction, without contraindication to beta-blocker treatment, can be treated with timolol 10 mg twice daily to reduce mortality and reinfarction. In contrast to previous routines, secondary prevention with beta blockers should be especially directed to high-risk patients.
 ...
PMID:Secondary prevention after myocardial infarction: subgroup analysis of patients at risk in the Norwegian Timolol Multicenter Study. 388 63

Beta-adrenergic blocking drugs are gaining acceptance as initial therapy for patients with mild to moderate hypertension. In a postmarketing surveillance study, 5,190 hypertensive patients received timolol maleate monotherapy and were evaluated by 1,355 physicians. A total of 1,057 patients did not complete the study: 28% of these patients experienced an adverse event. Mean systolic and diastolic blood pressure readings were reduced 20 and 13 mm Hg, respectively. Mean diastolic blood pressure was reduced 11% for patients with mild hypertension; larger mean reductions were noted for patients with moderate (17%) and severe hypertension (22%). The effect in black and elderly patients was less than in other groups. Although 22% of all patients experienced an adverse event, less than 2.2% of all patients experienced events related to beta-adrenergic blockade, ie, respiratory difficulty, heart failure, bradycardia, and cold extremities. Fatigue, dizziness, and nausea were the most frequently reported adverse events requiring discontinuation of therapy. Timolol monotherapy is a well-tolerated and effective treatment for a broad range of hypertensive patients.
 ...
PMID:Clinical experience with timolol maleate monotherapy of hypertension. 396 44

All available beta-adrenergic blocking agents share the property of blocking beta 1 adrenoceptors, including those in the heart. They differ, however, in their ability to block beta 2 receptors (cardioselectivity), their membrane stabilizing action, intrinsic sympathomimetic activity and their pharmacokinetic properties. The strongest evidence for efficacy in secondary prevention has been obtained with timolol, metoprolol and propranolol. Timolol and propranolol block all beta-receptor-mediated responses and are therefore nonselective, whereas metoprolol is relatively cardioselective. Propranolol and metoprolol have membrane stabilizing action, but timolol does not; none of these agents show intrinsic sympathomimetic activity. Thus, no ancillary property is a requirement for efficacy. All of these agents may precipitate heart failure, but this problem has been exaggerated, and transient failure during the early course of myocardial infarction is no longer a contraindication to therapy. Cardioselective agents cause less bronchospasm, but this can still occur, especially with higher dosages. In addition, these agents probably cause somewhat less fatigue and result in less hypertension during hypoglycemia than nonselective agents. The availability of at least three effective agents allows for a choice of therapy to offer individual patients.
 ...
PMID:Clinical pharmacology of the beta-blocking drugs: implications for the postinfarction patient. 613 42

Timolol, a nonselective beta-adrenoreceptor blocking agent without intrinsic sympathomimetic or membrane stabilizing activity, has been shown effective in the treatment of angina and hypertension. It is particularly useful in patients with stable angina pectoris and patients with mild to moderate hypertension. In both of these conditions, timolol appears to be comparable to propranolol. A recent study has suggested that timolol reduces mortality and reinfarction rate in patients who have recently had a myocardial infarction. When given topically timolol reduces intraocular pressure in patients with open-angle glaucoma; the drug may be used as the primary agent or as an adjunct to standard therapy. Careful selection of patients will reduce the frequency of adverse effects due to beta-receptor inhibition. Thus, timolol should not be used in patients who are predisposed to asthmatic bronchitis or cardiac failure, and it should be used with caution in patients with peripheral vascular disease or diabetes mellitus.
 ...
PMID:Pharmacokinetics, mechanisms of action, indications, and adverse effects of timolol maleate, a nonselective beta-adrenoreceptor blocking agent. 676 88

Timolol has become so populat with ophthalmologists that it is prescribed 44% of the time when an anti-glaucoma drop is needed. This popularity is due to its newness and the publicity it has received, its effectiveness in most types of glaucoma, and the apparent scarcity of side effects. This paper looks at the first 489 patients treated with timolol at Wills Eye Hospital and the side effects encountered. These include blurring of vision, burning and pain, bradycardia and heart failure, hallucinations, dilated pupils, headaches, dizziness, hypotony, allergy, asthma, impotence, drowsiness, anxiety, emotional lability, and nausea.
 ...
PMID:The place of timolol in the practice of ophthalmology. 740 91

Topically administered beta blockers are the preferred medical therapy for glaucoma. These agents reduce intraocular pressure (IOP), thereby preventing damage to the optic nerve and the subsequent loss of vision. Timolol, betaxolol, levobunolol, metipranolol, and carteolol are the topical beta blockers available in the U.S. They have similar IOP-lowering efficacy, but differ in other pharmacological properties. Topically administered beta blockers are generally well tolerated. They undergo systemic absorption, however, and can adversely affect cardiovascular and bronchopulmonary function in patients with existing diseases such as heart failure, sinus bradycardia, chronic obstructive airways disease, or asthma. Betaxolol, which is beta 1-selective, and carteolol, which has intrinsic sympathomimetic activity (ISA), may have systemic tolerability profiles superior to the traditional nonselective, non-ISA beta blockers. These hypotheses require confirmation in controlled clinical trials. Local adverse effects associated with beta blockers include stinging, burning, red eye, itching, tearing and loss of corneal sensitivity. Stinging upon instillation is a particularly frequent finding with betaxolol (up to 30% to 40% of patients). Preliminary evidence suggests that carteolol has the best local tolerability profile of these drugs.
 ...
PMID:Topical ophthalmic beta blockers: a comparative review. 790 96

Since the development of beta-adrenergic blocking agents over 30 years ago, they have been established as an important therapeutic modality in the treatment of coronary heart disease. This article reviews the role of beta-blockers in the treatment of hypertension, angina, acute myocardial infarction, and heart failure. A number of multicenter studies indicate that beta-blockers have an important effect in decreasing morbidity and mortality in patients with hypertension and appear to have a relatively increased importance in elderly patients with hypertension. Although their long-term effects on the mortality of angina pectoris have not been fully investigated, investigations indicate that, compared with other drugs, beta-adrenergic blocking agents significantly decrease the frequency and duration of angina pectoris. The largest use of these drugs has been examined in the treatment of acute myocardial infarction. Two major trials, the Norwegian Timolol Trial and the Beta Blocker Heart Attack Trial, confirm the long-term benefit in patients following acute myocardial infarction. Their use in heart failure is under close investigation following a series of preliminary studies suggesting they may decrease mortality risk. Although the tolerability of these drugs has been questioned, careful examination of clinical trials indicate that they are relatively well tolerated. These observations emphasize the importance of beta-adrenergic blocking agents in hypertension, angina, and acute myocardial infarction and speak to a wider clinical use of these drugs.
 ...
PMID:Beta-blocking drugs and coronary heart disease. 921 Oct 14

In heart disease, differences exist between women and men with respect to the impact of risk factors, symptoms, and therapeutic responses. The use of beta-adrenergic receptor blockers is now well established in the treatment of mild and moderate systolic heart failure. Although there are significant differences among agents, their clinical effects are predictable. To address the question of sex disparities in the heart, however, we investigated the effect of treatment with the nonselective beta-blockers timolol and propranolol on mechanical and electrical function of heart preparations from male and female rats. We examined the long-term effects of intragastric treatment with timolol (5 mg/kg per day) or propranolol (25 mg/kg per day) for 7 months on the hemodynamic and intracellular action potential parameters of the heart. Chronic administration of timolol but not propranolol produced a significant increase in the baseline activity of the left ventricular developed pressure (LVDP) in both male and female rats with no significant effect on the left ventricular end-diastolic pressure. Timolol or propranolol treatment of male rats and timolol but not propranolol treatment of female rats induced significant shortening in the repolarization phases of action potentials recorded from left ventricular papillary muscle strips of the hearts. The responses of LVDP to beta-adrenergic stimulation were similar in timolol- or propranolol-treated or untreated male rats. On the other hand, timolol treatment markedly increased, and propranolol treatment significantly decreased, the responses of increase in LVDP in female rats. Our results suggest that although treatment with beta-blockers for 7 months confirmed the role of the beta-adrenergic pathway in heart function, there are marked differences in the effects of individual beta-blockers on heart physiology. Sex differences should be taken into consideration when using beta-blockers during experimental studies and clinical therapy.
 ...
PMID:Effects of beta-adrenergic receptor blockers on cardiac function: a comparative study in male versus female rats. 1937 84