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Side effects of atenolol weight gain: Beta blockers: Do they cause weight gain?

by alexxlab

Beta Blockers & Weight Gain: Metoprolol, Bisoprolol, Atenolol

Beta blockers have been used for decades for the treatment of high blood pressure and other cardiovascular diseases. In fact, they are one of the most commonly prescribed classes of medications in the United States. Weight gain is a common but underrecognized side effect of beta blockers. In this article we’ll explore the relationship between beta blockers and weight gain and what you can do about it.

What Are Beta Blockers?

Beta blockers are a class of medications that cause the heart to beat more slowly and with less force. They do this by blocking the effects of the hormone epinephrine, also known as adrenaline. Some beta blockers also cause relaxation of the blood vessels. Given these effects, they are primarily used for the treatment of high blood pressure and other cardiovascular diseases such as heart failure and arrhythmias. They may also be prescribed for the treatment of migraine headaches, anxiety, hyperthyroidism, and tremors. Common beta blockers include: 

  • Atenolol (TenorminⓇ)
  • Carvedilol (CoregⓇ) 
  • Labetalol (TrandateⓇ) 
  • Metoprolol (LopressorⓇ) 
  • Nebivolol (BystolicⓇ) 
  • Propranolol (Inderal LAⓇ) 
  • Sotalol (BetapaceⓇ) 

What is the Relationship between Beta Blockers and Weight Gain?

According to an article published in Hypertension, the potential for beta blockers to cause weight gain has been known for years. Multiple studies of participants on beta blockers for treatment of high blood pressure found that those who were taking a beta blocker weighed an average of 2.6 pounds more than those who were not. They also found that this weight gain occurred within the first few months of starting on the medication. While 2.6 pounds was an average, so it’s possible that some participants gained even more weight and some less. It is unknown at this time who is more susceptible to weight gain with beta blocker use.

How do beta blockers affect weight loss efforts?

There is also research to suggest that some beta blockers may also affect a person’s ability to lose weight. In a study looking at participants enrolled in a diet and exercise program, those who were taking older beta blockers such as metoprolol, atenolol, propranolol, and bisoprolol lost less weight than those who were not on a beta blocker or were on a newer beta blocker. The difference in weight loss ranged from 2-7%, which can make a significant difference in  your health. For example, losing just 5% of your body weight can improve blood pressure and reduce the risk of cardiovascular diseases. These are often the reasons for beta blocker therapy in the first place. 

It’s important to note that not all beta blockers have these potential adverse effects on weight, though. Studies have shown that newer beta blockers such as carvedilol do not cause weight gain in the same way as older beta blockers such as metoprolol. There is even data to suggest that patients taking these newer beta blockers (carvedilol, nebivolol, and labetalol) may have more success with a weight loss program than those not taking a beta blocker at all, but more research is needed in this area.  

How Do Beta Blockers Cause Weight Gain?

Beta blockers can cause weight gain because they lower total daily energy expenditure. Additionally, beta blockers slow down heart rate, which can make physical activity feel more difficult and exhausting. This may limit a person’s desire to continue exercising.

When taking a beta blocker keep in mind that weight gain can happen for other reasons. For example, if you have a history of heart failure, a sudden increase in your weight can be a sign that your heart failure is getting worse. For this reason, it is important to track your weight closely and notify your healthcare provider if you notice a sudden change in your weight. 

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How to Prevent Weight Gain While on Beta Blockers

If you’ve been prescribed a beta blocker and are wondering if it has affected your weight, it’s a good idea to discuss options with your healthcare provider. If the beta blocker is solely being used to treat high blood pressure, there may be other medications available to you that are less likely to cause weight gain. Alternatively, there may be the option to switch to a beta blocker that is less likely to cause weight gain, such as carvedilol or nebivolol. Please note that it is not recommended to stop taking any prescribed medication without discussing with your healthcare provider. 

If it is recommended to stay on a beta blocker that has weight gain potential, it does not mean you are destined to gain weight or that you’ll be unable to lose weight.  Here are some tips to help you achieve a healthy weight: 

1) Eat nutritious foods

Consuming vegetables, fruits, lean protein, whole grains, and healthy fats (like nuts, seeds, avocado, and fish) is essential for weight management and overall health. In fact, research has shown that healthy nutrition can lower blood pressure as effectively as medication! Implementing these changes can be challenging, so working with a Registered Dietitian is a great way to get started. 

2) Move more

Activity is an important component for successful and sustained weight loss. It has also been shown to improve blood pressure and lower the risk for heart disease.  Keep in mind, any activity counts. Whether it’s going to the gym, taking a walk, putting the laundry away or trying out some seated exercises, consider where you can add more movement to your day.  If you haven’t exercised for a while or are new to it, it’s recommended you talk to your doctor before starting. 

3) Keep yourself on track

Self-monitoring, such as tracking what you eat, your physical activity, and your weight has been shown to help weight loss. It also allows you to intervene sooner if you start to notice your weight is increasing and provides you with a better understanding of what has caused that change.  

4) Get adequate sleep

Poor sleep is a known contributor to weight gain.  If you’re not doing so already, try to practice healthy sleep habits. Give yourself at least 7-8 hours of time to sleep and going to bed around the same time each night.  If you’re struggling with your sleep, be sure to talk to your doctor. 

How FORM Can Help You With Weight Gain from Beta Blockers

At FORM, you work with a Board Certified Doctor and Registered Dietitian who are experts in weight management. Your doctor will conduct a thorough evaluation to identify various factors that may be affecting your weight. This will include a review of the medications you are taking. Many medications can potentially cause weight gain or make losing weight more difficult, not just beta-blockers. 

Your doctor will work with you and your healthcare providers to evaluate if medication may be affecting your weight. Furthermore, both your doctor and Registered Dietitian take into consideration your medical history, such as high blood pressure or cardiovascular disease, when formulating your personalized weight loss plan. Your plan will include nutrition, physical activity and mindset shifts, as well as FDA-approved medications, if appropriate. If you’re looking for individualized guidance towards a healthy weight, Form Health’s Medical Weight Loss may be right for you. 

Take our quiz to find out if you’re a candidate today, or schedule a call/send a message to get in touch with us directly.

TenorminⓇ is a registered trademark of Astrazeneca. 

CoregⓇ is a registered trademark of GlaxoSmithKline

TrandateⓇ is a registered trademark of Prometheus Laboratories, Inc.

LopressorⓇ is a registered trademark of Validus Pharmaceuticals, Inc.

BystolicⓇ is a registered trademark of Allergan, Inc.

Inderal LAⓇ is a registered trademark of Akrimax Pharmaceuticals

SotalolⓇ is a registered trademark of Covis Pharma

About the Author: Brooke Marsico, PA-C, completed her physician assistant training at Midwestern University in 2011. She began her practice in the field of Obesity Medicine at Northwestern Memorial Hospital in Chicago where she practiced from 2016 to 2021. She went on to treat patients living withobesity at Cleveland Clinic from 2021 to 2022 prior to joining the team at Form Health. Brooke is passionate about helping patients living with obesity achieve meaningful weight loss and improve their health. Her practice focuses on individualized behavioral and pharmacological intervention to help patients reach their goals. She is also experienced in managing patients who have a history of bariatric surgery.

Do Beta-Blockers like Metoprolol Cause Weight Gain?

If you’ve ever been prescribed a medicine called metoprolol, you may have heard about or experienced weight gain as a side effect.

Concerned about your weight? You aren’t alone. Close to 3 in 4 adults aged 20 and over are overweight or obese, according to the Center for Disease Control and Prevention. 

Obesity increases the risk of numerous diseases, including heart disease, diabetes, and some cancers. Many people taking metoprolol may already be overweight or have risk factors for diseases.

This article will answer some common questions about metoprolol and weight gain.

What is Metoprolol?

Metoprolol is a beta-blocker, a class of medications prescribed for high blood pressure. 

It’s available by prescription as a tablet and as a long-acting (extended-release) tablet.

Metoprolol works by slowing your heartbeat and relaxing blood vessels. This improves blood flow and reduces blood pressure.

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Metoprolol Uses

Metoprolol is often prescribed for high blood pressure, also known as hypertension. 

The medicine is also sometimes used for irregular heartbeat, migraine headaches, and for movement disorders caused by some psychiatric medications.

Metoprolol and Weight Gain

Metoprolol can cause weight gain as a side effect. Studies have shown that people taking metoprolol gain a median of 2.64 pounds compared to people who aren’t. 

Weight gain caused by metoprolol typically occurs within the first few months of taking it. After that, any gains tend to level off as your body adjusts.

Curious how metoprolol causes people to gain weight? While experts are unsure why, there are a few possible factors.

It may be caused by changes to your metabolism that affect how your body processes fats and how insulin affects the cells that store and release sugar.

Another reason experts think metoprolol may cause weight gain is fatigue.

When you take beta-blockers, it can make you less energetic and less likely to move around, which can lead to putting on weight. 

Metoprolol is thought to cause you to gain more abdominal fat, which is related to problems with high cholesterol.

Other Beta Blockers That Cause Weight Gain

Metoprolol isn’t the only beta-blocker that can cause weight gain – atenolol and propranolol can cause it too.

However, some beta-blockers don’t appear to cause weight gains, such as timolol, acebutolol, and carvedilol.

A study on people with type 2 diabetes taking metoprolol for high blood pressure compared to another newer beta-blocker, carvedilol, found that carvedilol didn’t cause weight gain, but metoprolol did.

The reasons your healthcare provider may choose one beta-blocker over another can vary depending on your individual health needs.

If you’re prescribed a beta-blocker and are concerned about gaining weight, don’t hesitate to talk to your doctor.

How Much Weight Gain is Too Much?

People who take metoprolol and have weight gain as a side effect tend to gain around two to three pounds over a few months.

However, if you’re taking metoprolol for heart failure, a sudden weight gain can mean that fluid is building up if your heart failure is getting worse.

Reach out to your healthcare provider if you gain more than two to three pounds in one day or five pounds in one week.

Tips for Losing Weight on Beta-Blockers

Even modest weight loss can improve your health dramatically. Losing just 5-10% of your body weight can reduce your risk for heart disease, stroke, and diabetes.

If you have high blood pressure and you’re overweight, losing a few pounds can help with your blood pressure and cholesterol.

Healthy weight loss isn’t always just about diet – it’s also about long-term health habits, including: 

  • Exercise
  • Sleep
  • Stress reduction

Diet Changes

A healthy eating plan stays within your calorie needs and is rich in fruits, vegetables, whole grains, and low-fat dairy products. 

Protein from a variety of sources is best, such as: 

  • Seafood
  • Lean meats and poultry
  • Eggs
  • Legumes
  • Soy products
  • Nuts
  • Seeds

Sugars, sodium, and fats should be limited. Stick to water instead of high-calorie or sweetened beverages.

Some drinks can help with blood pressure too, such as tomato juice and beet juice.

Regular Exercise

Physical activity is good for maintaining a healthy weight and overall health. It can help reduce the risk of high blood pressure, type 2 diabetes, heart attack, stroke, and even some forms of cancer.

Exercise also can help with arthritis, bone health, and mental health.

If you want to lose weight, it’s best to combine exercise with healthy changes in nutrition. 

To maintain your healthy weight, experts recommend that you work your way up to 150 minutes of moderate-intensity exercise, 75 minutes of vigorous-intensity exercise, or an equivalent mix of the two every week.

Avoid Smoking

Smoking cigarettes harms every part of the body. If you use tobacco, one of the best things you can do for your health is to quit. 

Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD). 

Smoking also increases the risk for tuberculosis, certain eye diseases, and immune system problems.

It’s never too late to quit smoking, and there are medications available that can help. Reach out to your healthcare provider for support.

Alternative Medications

If you have high blood pressure and are prescribed medication to treat it, your doctor will talk to you about the reasons they choose a particular medication and why that’s right for you.

If you’re concerned about weight gain, you should mention this to your doctor to see if there is a different option that would also work for you.

Metoprolol can cause weight gain, but some other beta-blockers don’t appear to cause weight gain, such as timolol, acebutolol, and carvedilol.

Beta-blockers aren’t the only medications used for high blood pressure.

Another class of medications called angiotensin-converting enzyme (ACE) inhibitors – such as enalapril, lisinopril, and ramipril – don’t cause weight gain.

Angiotensin II receptor blockers (ARBs) are also commonly prescribed for high blood pressure, including telmisartan, losartan, olmesartan, irbesartan, and valsartan.  These medications don’t cause weight gain.

Calcium channel blockers are another class of drugs used for blood pressure that doesn’t cause weight gain, including amlodipine and diltiazem.

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Refill medications and get certain necessary prescriptions.

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When to See a Healthcare Provider

Tell your healthcare provider if you suddenly gain more than two to three pounds in one day or five pounds in one week. 

If you’re taking a beta-blocker for heart failure, weight gain can be a sign that fluid is building up in your body.

This can indicate your heart failure is getting worse, and your doctor will need to evaluate you to determine the cause.

How K Health Can Help

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Frequently Asked Questions

Why Does Metoprolol Make You Gain Weight?

Experts don’t know for sure the reasons metoprolol causes weight gain. There may be a few possible factors, such as changes in your metabolism, how your body processes fat, and how insulin affects your cells.

Weight gain may also be due to metoprolol causing side effects such as tiredness and low energy, resulting in less physical activity throughout the day.

How Do I Not Gain Weight on Metoprolol?

Not everyone who takes metoprolol will gain weight. Some people experience side effects of weight gain with beta-blockers, while others don’t.

If you’re prescribed metoprolol, follow healthy habits such as good nutrition and physical activity. Keep track of your weight and habits so that you can talk to your doctor about a weight management plan that’s right for you.

Can You Lose Weight While on Beta-Blockers?

For people who are overweight and take metoprolol or other beta-blockers for high blood pressure, weight management may be more difficult.

It’s important to follow a healthy diet, get plenty of sleep, and exercise regularly to manage your weight and improve your health. Talk to your healthcare provider if you’re on a beta-blocker and have questions about losing weight.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions,
and medical associations. We avoid using tertiary references.

  • Body weight changes with beta-blocker use: results from GEMINI. (2007).
    https://pubmed.ncbi.nlm.nih.gov/17602935/

  • Comparison of weight reduction with metoprolol in treatment of hypertension in young overweight patients. (1985).
    https://pubmed.ncbi.nlm.nih.gov/2860441/

  • Health Effects. (2020).
    https://www.cdc.gov/tobacco/basic_information/health_effects/index.htm

  • Healthy Eating for a Healthy Weight. (2022).
    https://www.cdc.gov/healthyweight/healthy_eating/index.html

  • Healthy Weight, Nutrition, and Physical Activity. (2022).
    https://www.cdc.gov/healthyweight/index.html

  • Hypothesis: β-Adrenergic Receptor Blockers and Weight Gain. (2001).
    https://www.ahajournals.org/doi/10.1161/01.hyp.37.2.250

  • Hypothesis: Beta-adrenergic receptor blockers and weight gain: A systematic analysis. (2001).
    https://pubmed.ncbi.nlm.nih.gov/11230280/

  • Managing Heart Failure Symptoms. (2017).
    https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure/managing-heart-failure-symptoms

  • Medications that cause weight gain and alternatives in Canada: a narrative review. (2018).
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109660/

  • Metoprolol. (2017).
    https://medlineplus.gov/druginfo/meds/a682864.html

  • Obesity and Overweight. (2022).
    https://www.cdc.gov/nchs/fastats/obesity-overweight.htm

  • Physical Activity for a Healthy Weight. (2022).
    https://www.cdc.gov/healthyweight/physical_activity/index.html

Psychologist’s advice

GETTING BECOME FROM … TREATMENT

It is very common to hear from patients that they recovered after starting oral contraceptives, or after antibiotic treatment, or after a fracture (surgery), and since then they have only gained weight. Is it possible? And how to deal with this weight “from pills”?
Weight gain after treatment of any diseases is quite likely, but this is not such a frequent occurrence. Now, thank God, there is more than enough information, annotations for any drug are easy to find on the net, and there they usually indicate “weight gain” as one of the side effects. What to do? Refuse treatment? Should I choose another drug? Increase physical activity and limit nutrition? It is not always possible. But first, you should know which drugs can lead to weight gain.

Oral contraceptives are mentioned first in this list in terms of the frequency of mentioning in the network as perhaps the main reason for excess weight. It has become almost an axiom, they say, I started taking pills, wait for weight gain. Why is this myth so alive? Yes, because our mothers and grandmothers knew this for sure, they were afraid of these drugs, but they also had different pills. Oral contraceptives of the first and second generations contained a large amount of sex hormones, while the degree of their purification was far from ideal, and no one had previously done a “hormonal mirror”. Because of this, women’s metabolism changed, appetite increased, which had a detrimental effect on the figure. Modern combined oral contraceptives (COCs) do not give such an effect. However, everything is very individual here, and only a doctor should prescribe these drugs after the tests. This also applies to hormonal drugs that are prescribed for menopause, so that there are no hot flashes. Doses should be prescribed strictly individually, depending on the specific characteristics of the individual.
A small weight gain when taking these drugs can only be caused by temporary fluid retention, which is easily managed by adjusting the diet (reducing salty, smoked and fatty foods, increasing fiber and water in the diet) and physical activity (try to sit less and more walk during the day). But often the true cause of weight gain when taking COCs is still a decrease in motor activity and / or an increase in calorie intake. Most often, the start of taking oral contraceptives coincides with a change in marital status, which entails changes in lifestyle (and here there may be late dinners with a loved one, and a desire to stay at home in the evening, and not go to fitness, etc.). In general, there are quite a few factors that affect weight (besides drugs), and this should always be taken into account before blaming “bad pills” for everything.
However, when taking sex hormone preparations, you can gain excess weight, for example, on ovulation stimulating drugs (in preparation for IVF) or progesterone analogues, which are used to treat female diseases (uterine fibromyoma, cycle disorder), these are duphaston, turinal. Excess weight can also appear when taking medications for the treatment of infertility.
But there is another fairly common group of hormonal drugs that can actually cause weight gain – these are glucocorticosteroids (prednisolone, dexamethasone, polcortolone, etc.). These are artificial analogues of hormones produced in the adrenal glands, which are used to treat bronchial asthma, rheumatoid arthritis and some other serious diseases.
If a doctor prescribes long-term use of such medications, a very specific type of obesity occurs: the arms and legs lose weight, and the bulk of the fat is deposited in the upper half of the body. At the same time, the face becomes moon-shaped, the neck and shoulders become very stout.
This effect can be avoided if topical glucocorticosteroids are used. For example, in bronchial asthma they are injected directly into the bronchi by inhalation, and in arthritis – into the cavity of the diseased joint. In general, drugs can cause weight gain in two ways: by stimulating appetite and by altering metabolism. A strong feeling of hunger occurs, for example, when taking anticonvulsant drugs, which are prescribed to patients with epilepsy. Psychotropic drugs have the same side effect. These include antidepressants and antipsychotics, which are used to treat intense feelings of fear and anxiety, depression, and schizophrenia.
Very often, depression is the “sister” of such terrible eating disorders as anorexia and bulimia. Depression, in principle, in itself can contribute to uncontrolled weight gain. Food, or rather the process of eating itself, helps to drown out feelings of anxiety and anxiety, and many patients unconsciously resort to this method to slightly improve their mood. And taking antidepressants, which are prescribed for these diseases, can further increase appetite. It turns out a vicious circle, when weight gain on antidepressants exacerbates depression. True, in the case of the latter, their effect on appetite, and hence weight, depends on the symptoms of depression. However, you can get quite noticeably better only when taking outdated tricyclic antidepressants that increase appetite: amitriptyline, anortriptyline and doxepin – up to 5% of the initial body weight for 18 months.
Antipsychotics (Zyprexa and Clozaril), antidiabetic drugs (insulin, maninil, diabetone), antiulcer drugs (lansoprazole, esomeprazole, pantoprazole, cimetidine), antiemetics (metoclopramide) drugs, as well as drugs that normalize work of the gastrointestinal tract (domperidone).
Hypertensive patients need to be careful – to normalize blood pressure, they are often prescribed beta-blockers (metoprolol and atenolol), while after using beta-blockers it is quite difficult to lose weight, possibly because they reduce the metabolic rate.

Sleeping pills and antiallergic drugs can cause drowsiness, fatigue, which in turn leads to a decrease in physical activity. As a result, a person spends fewer calories during the day than usual, which leads to a gradual increase in body weight. Some anti-allergic drugs, such as ketotifen, can increase appetite, but by adjusting the dosage or replacing the drug with another one, the situation can be changed.
But do not think that only medicines used for serious illnesses lead to weight gain. Sometimes to provoke an increase in body weight can means that everyone can take from time to time. For example, such well-known painkillers as indomethacin and diclofenac. True, extra pounds in this case appear due to fluid retention in the body, after the end of treatment, the water leaves – and the weight returns to normal.
And now about antibiotics, which are so widely used in our medicine that they have now become almost familiar medicines for common colds and any increase in temperature. However, when we read the annotations for antibiotics, we always see a long list of various side effects that can occur when taking them, ranging from diarrhea and allergies to hallucinations. But in any instruction, in any drug you will not see even a hint that taking antibiotics can lead to weight gain.
However, in recent years, researchers around the world have sounded the alarm: “The rise in obesity worldwide has coincided with the widespread use of antibiotics. It is possible that early exposure of a child to antibiotics predetermines obesity in later years of life.”
The well-known journal New Scientist published an article suggesting that “the abuse of antibacterial drugs can be a serious impetus to obesity.” The explanation given by the author of the article is very simple – antibiotics reduce the amount of beneficial flora in the intestines. It turns out that in addition to the fact that the microflora protects us from infections, it also prevents obesity.
Overweight in children may be associated with antibiotics. Taking such drugs at an early age, especially in the first five months of life, in some cases leads to metabolic disorders in the body.

I’m not going to retell you a lot of research and observations conducted around the world. Of course, these conclusions are certainly not final. But do not neglect the data obtained – it is better to think about the fact that the unreasonable use of such drugs can sometimes not lead to the result we expect.
If you are already inclined to be overweight, check with your doctor if it is possible to replace the drug with another one that is similar in effect, but not “fat”. If for treatment you need exactly the drug that can provoke weight gain, increase physical activity if possible, review your diet and be sure to exclude flour and sweets from the menu.

Psychologist Ananich

Effectiveness of beta-blockers in the treatment of idiopathic ventricular extrasystoles in children | Alekseeva

Ventricular extrasystole (VEC) is a common heart rhythm disorder (HRD) in the pediatric population [1-5]. Its occurrence depends on the age of the child. Thus, in children of the first years of life
, the frequency of occurrence of PVC according to the data of daily monitoring of the electrocardiogram (ECG) (SMEKG) is 18%, and in healthy adolescents it is already 30%, however, frequent PVC and non-sustained ventricular tachycardia (VT) are recorded much less frequently, in 2 -5% of cases [4][5]. The prognosis in children with frequent idiopathic PVCs is considered favorable, therefore, few of them are prescribed antiarrhythmic therapy (AAT), indications for which are patient complaints and the risk of developing arrhythmogenic myocardial dysfunction [5]. According to clinical guidelines, beta-blockers (β-blockers) are the first-line drugs in the treatment of ventricular arrhythmias in children [3, 5]. The most commonly used in pediatric practice are propranolol, atenolol and metoprolol. β-ABs have negative chrono-, dromo-, and inotropic effects, and due to their ability to suppress automatism of heterotopic foci of excitation in the myocardium, they are widely used as AATs [6].

The problem of AAT in children with PVC is relevant in the practice of a pediatric cardiologist, incl. due to age restrictions for radiofrequency ablation. In the literature, there are a limited number of studies on AAT in children with PVCs, which include small patient cohorts and show conflicting results [7][8]. The aim of this study was to evaluate the effectiveness of β-blockers in the treatment of idiopathic PVCs in children.

Material and methods

The study was conducted in St. Petersburg State Budgetary Health Institution “Children’s City Multidisciplinary Clinical Specialized Center for High Medical Technologies” (St. Petersburg) in the period from 2018 to 2022.

The study included 27 children with idiopathic PVCs. When choosing an effective dose of β-AB, 2 adolescents aged 15 and 16 had hypotension accompanied by dizziness, one 5-year-old child developed bronchial obstruction, and therefore therapy was canceled in these patients. These three patients were excluded from the analysis, the effectiveness of AAT was evaluated in the remaining 24 people.

Inclusion criteria were: age under 18, PVC requiring AAT, absence of organic and inflammatory heart diseases, absence of electrolyte and hormonal disorders, absence of contraindications for prescribing β-AB (bradycardia, atrioventricular conduction disorders, broncho-obstructive pulmonary diseases, etc. .), the duration of observation after the appointment of AAT (β-AB) > 6 months.

The study was approved by the ethics committee of the St. Petersburg State Pediatric Medical University of the Russian Ministry of Health. AAT was prescribed according to national recommendations [5]. Off-label drugs used in childhood were prescribed after a medical commission and the signing of a voluntary informed consent by the legal representative of the child.

All children underwent general and biochemical blood tests with assessment of inflammation markers, electrolyte and hormonal status, 12-lead ECG, SMEKG, echocardiography. Congenital heart defects, cardiomyopathies, and inflammatory heart diseases were excluded. Left ventricular (LV) size and LV ejection fraction (EF) were assessed according to a standard protocol using the Teichholz method, measured on normal heart beat, and indexed by body surface area and the Boston Children’s Hospital Z-score (https://zscore.chboston.org /).

β-ABs were used as AAT: propranolol or metoprolol. The initial dose of propranolol was 0.5-0.7 mg/kg/day. with a multiplicity of reception 3-4 times / day, the maximum dose is 2.5 mg / kg / day. (40 mg 3 times / day in adolescents). The initial dose of metoprolol was 0.5 mg/kg/day. with a multiplicity of reception 2 times / day. (12.5 mg 2 times / day in adolescents), the maximum dose is 2 mg / kg / day. (50 mg 2 times / day in adolescents). β-ABs were prescribed after SMEKG, under daily clinical and ECG monitoring during the period of drug dose selection. The therapy was considered effective if the number of PVCs decreased by more than 50% per day, the number of paired PVCs decreased by at least 90% and no VT runs.

Statistical processing of the study data was carried out using the “Data Analysis” modules of the Microsoft Excel editor and the STATISTICA 10 program. The description uses: the mean value of the data (M) and standard deviation (M ± SD). Qualitative indicators are presented as absolute (n) and relative (%) units. To compare qualitative features, the χ2 criterion was calculated. The level of statistical significance was taken as p<0.05.

Results

Among 24 children with PVCs, there were 15 (62.5%) boys and 9 (37.5%) girls. The average age was 8.3±5.4 years (6 days of life (days) – 15 years). The group of children under 1 year old (mean age 31.5±22.1 days/day (6-60 days)) included 8 (33.3%) children, the group of preschoolers (mean age 5.7± 0.9 years (5.0-7.0 years)) – 4 (16.7%) people, schoolchildren (mean age 12.2±1.8 years (9-15 years)) amounted to 12 (50.0 %) Human.

According to the SMEKG data, the daily representation of PVCs was 33.2±17.7 (5.3-66.0) thousand/day. or 26.6±13.2% (6.0-52.3%). 14 (58.3%) children had paired PVCs, among them 10 (41.7%) also had unstable VT runs, 3 (12.5%) children had polymorphic PVCs. Based on the morphology of ectopic complexes, the localization of the VEC focus was determined: in 18 (75.0%) children – the right ventricle, in 6 (25.0%) children – the LV.

Indications for AAT prescription were: frequent PVCs (>25% of circadian rhythm) and/or “complex forms” of PVCs (prolonged bigeminy, steamy, polymorphic PVCs, unsustainable VT runs) (Fig. 1).

Fig. 1. Fragments of SMEKG of girl Ch., 14 days old. Frequent polymorphic PVCs, intermittent jogging VT.

In the group of children under 1 year old, according to echocardiography, the end-diastolic size of the left ventricle was initially 20.5±2.6 mm (16.7-22.5), which corresponded to the Z-score parameters of 1.0±0.85 (- 0.44-1.7). One child from this group had a slight dilatation of the left ventricle without a decrease in EF (73. 9%) with a decrease in LV size against the background of effective AAT (22.4 mm, Zscore 1.77 vs 21.0 mm Zscore 1.13). In the group of preschool children, the LV size was 35.9±2.0 mm (33.6-37.5), which corresponded to the average Z-score of -0.6±0.8 (-1.53-1.63 ). In the group of school-age children, the mean LV size was 43.6±5.7 (36.4-56.0), Zscore -0.85±0.9 (-3.44-0.43). A significant deviation from the norm (Z-score -3.44) towards a lower value was noted in a 14-year-old boy with obesity (body mass index 34.2, body surface area 2.23 m2), which was not regarded as pathological in the structure of the existing HRS . There was no significant significance in the LV size in the groups of children with effective and ineffective therapy (p=0.73), as well as in the Z-score parameters (p=0.47).

7 (29.2%) children had complaints. The most frequent complaints (in 5 (20.8%) patients) are interruptions, palpitations, tingling in the region of the heart. 3 (12.5%) children complained about syncope and presyncope, but they were vegetative or situational in nature (in a stuffy room and against a background of high temperature). A decrease in exercise tolerance and increased fatigue were noted by 3 (12.5%) children. However, they did not show any signs of LV dysfunction. In the group of children under 1 year of age, the hemodynamic effect of PVC was assessed taking into account the rate of weight gain. The median weight gain was 765±303 grams per month. Significant differences were not obtained in the groups of effective and ineffective therapy depending on the presence or absence of complaints (p=0.48).

The follow-up period was 369.8±119.1 days. A good effect of AAT was achieved in 11 (45.8%) patients. Against the background of effective therapy, the decrease in the number of PVCs was 76.4±16.8% (56.6-100%). Only in one case in a girl with right ventricular PVC, according to SMEKG, extrasystole was completely absent. Ineffective AAT therapy was recognized in 13 (54.2%) patients due to insufficient reduction in the number of PVCs (<50%) according to SMEKG. Also in this group, 5 (20.8%) children showed an increase in the number of PVCs against the background of AAT by an average of 20. 5 ± 4.9% (16.4-27.7%).

In the group of children under 1 year old (n=8), the therapy was effective in 6 (75.0%) children, in the group of preschoolers (n=4) in 2 (50.0%) children, in the group of schoolchildren (n= 12) only in 3 (25.0%) patients. Thus, the effectiveness of AAT was higher in children under the age of 1 year (75% vs 31.3% in children older than 1 year; p=0.043).

17 (70.8%) patients received propranolol. The starting dose was 0.7±0.2 mg/kg/day. with an increase to 1.4±0.3 mg/kg/day. (1.2-2.5 mg / kg / day). The average age of children was 5.2 ± 3.5 (6 days – 13.9years). A positive effect of propranolol was recorded in 10 (58.8%) people, an insufficient effect in 5 (29.4%), in 2 (11.8%) there was an increase in the number of PVCs.

7 (29.2%) children received metoprolol. The average age of children was 11.0±3.2 (5-15 years). The effectiveness of AAT was recorded in 1 (14.3%) child, ineffectiveness – in 6 (85.7%) children. Of the 5 children who had an increase in the number of VPCs while taking β-blockers, three received metoprolol. Thus, the efficacy of propranolol was significantly higher than that of metoprolol (58.8% vs 14.3%, p=0.047).

There were no significant differences in ECG parameters among children with effective and ineffective therapy. The following were assessed: the width of the QRS complexes (p=0.72), the average PVC linkage interval (p=0.82), the average heart rate according to the SMEKG data (p=0.28). The effectiveness of β-AB was noted more often in boys (9 young vs 2 girls), although without significant differences (p=0.07) (Table 1).

Table 1

Comparative characteristics of patients with PVC treated with β-AB, depending on the effectiveness of therapy


Abbreviations : VT – ventricular tachycardia, PVC – ventricular extrasystole, EDD – end-diastolic size, LV – left ventricle.

In most cases, 15 (62.5%) children had a mixed type of PVC circadianity, among them 7 (46.7%) children were treated effectively, 8 (53. 3%) were ineffective. In the group of children with a diurnal type of circadian VES (7 people), 4 (44.4%) patients had effective therapy. In 2 patients with nocturnal circadianity, β-blocker therapy was ineffective, and an increase in the number of PVCs was noted.

In 10 (41.7%) children, pathological parameters of turbulence (onset and / or slope of turbulence) were recorded, among them only 2 (20%) children were treated effectively. At the same time, in the group of children with normal turbulence parameters (9 (37.5%) people), β-blockers were ineffective in 3 (33.3%) children, effective in 6 (66.7%). Turbulence assessment was not possible in 5 children.

In a comparative assessment of preschool children (0-7 years old) and schoolchildren (7-15 years old), significant differences in the estimated parameters were obtained: PVC QRS width (p=0.003), PVC linkage interval (p=0.002), average frequency heart rate according to SMEKG (p=0.004), which is consistent with age-related differences in ECG parameters.

Discussion

β-ABs have been used for over 60 years since propranolol was first synthesized in 1962. β-ABs are included in Russian and international protocols for the treatment of many cardiac diseases in children and adults: arterial hypertension, chronic heart failure, hypertrophic cardiomyopathy, NRS, channelopathy, etc. [5][6][9]. At the same time, the spectrum of their influence is not limited only to cardiovascular pathology [6]. β-ABs have proven to be effective in the treatment of infantile hemangiomas, migraine, glaucoma, and a number of other diseases. β-ABs have negative chronotropic, dromotropic and inotropic effects, which are due to a decrease in the interaction of endogenous catecholamines with receptors, and their antiarrhythmic effect, in addition to limiting the neurosympathetic effect on the heart, is due to a decrease in the rate of spontaneous diastolic depolarization in heterotopic myocardial foci and a lengthening of the effective refractory period in ventricular cells [6][10].

The effectiveness of β-blockers in the treatment of PVC was most often evaluated in adult patients with coronary heart disease, after myocardial infarction. According to large randomized trials, β-blockers reduce the risk of SCD in patients after myocardial infarction, but they are inferior to other AAs in the treatment of PVCs, leading to a clinically significant decrease in symptomatic arrhythmias only in 12-24% of cases [9]. According to Doshchitsin V.L. et al. (2008) in adult patients with coronary heart disease and PVCs, the effectiveness of propafenone was 65%, amiodarone 62%, and metoprolol only 38.2% [11].

There is little information in the literature about AAT VEC in childhood. More often, such studies relate to the treatment of VT and “complex” forms of PVC (steam room, bigeminy, etc.). Thus, in the largest retrospective study of children with VT (73 children), it was shown that the effectiveness of β-blockers and sotalol is 35% and 62%, respectively, while propafenone and flecainide had an effectiveness of 65% [12]. Other studies based on small groups of children with ventricular arrhythmias also confirm the good efficacy of flecainide [7][13]. The results of the use of β-blockers in children with PVCs vary, there is evidence of a good efficacy of atenolol, but in most cases, β-blockers do not allow long-term and stable control of ventricular arrhythmia, although they are prescribed most often [7][13].

In our study, the effectiveness of β-AB was 45.8%, but mainly due to the group of children in the first year of life. The effectiveness of β-AB in children older than one year was lower – 31.3%, and in school-age children – only 25%. It cannot be ruled out that this is due to a better prognosis for various HRS in young children, in whom, with further formation of the structure of the heart, incl. conduction system of the heart, spontaneous disappearance of arrhythmia often occurs [3][14]. The older the child, the more stable the arrhythmia and the lower the effectiveness of AAT [14].

In addition, our study showed that different β-blockers differ in their effectiveness. In children receiving propranolol, the results of treatment were better, and metoprolol showed an extremely low efficiency – 14.3%. In addition, out of 5 children who had an increase in the number of VPCs while taking β-AB, three received metoprolol. All children of the first year of life received propranolol, it should be noted that this is the only AARP approved for use in children, the rest are prescribed off-label. It is known that propranolol is a non-selective β-AB, which, to a greater extent than metoprolol, has membrane stabilizing activity, which consists in reducing the membrane permeability for sodium and potassium ions, which is not associated with blocking β-adrenergic receptors, which is typical for Na-channel blockers [6] .

There is evidence of greater efficacy of β-blockers in the treatment of children with idiopathic VT from the outflow tract of the right ventricle [8]. However, in our study, despite the predominance of patients with PVCs from the right sections (75. 0%), the localization of the arrhythmia source did not affect the effectiveness of AAT.

The lowest efficiency of β-AB is demonstrated in patients with nocturnal circadian type of PVC [15]. Despite the fact that in our study only 2 patients had nocturnal circadian activity, both patients had an increase in the number of VPCs while taking β-blockers. In addition, there was a lower efficiency of β-AB in children with pathological parameters of rhythm turbulence. All this testifies to the important role of the autonomic nervous system in maintaining VES and in response to the use of β-blockers. It is possible that the peculiarities of the vegetative status of children under 1 year of age are one of the key points in the greater effectiveness of β-AB therapy.

Conclusion

β-ABs are first-line drugs in the treatment of ventricular arrhythmias, but they have low efficiency, which decreases with the age of the child, and in schoolchildren it is only 25%. The greatest efficiency of β-AB is in children under the age of 1 year.