road ahead with β-blockers: Expanding treatment options in cardiovascular disease: CME information

AJH 2005; 18:184S–187S THE ROAD AHEAD WITH ␤-BLOCKERS: EXPANDING TREATMENT OPTIONS IN CARDIOVASCULAR DISEASE CME INFORMATION Target Audience This program is designed for primary care physicians, specialists, nurse practitioners, physician assistants, and other health care professionals involved in the management and treatment of hypertension and cardiovascular disease. Statement of Need ␤-Blockers play a vital role in the management of hypertension and various forms of cardiovascular disease, including myocardial infarction, coronary heart disease, and heart failure, based on substantial clinical trial evidence. However, ␤-blockers are underutilized in these high-risk populations, at great clinical and financial costs. Evidence suggests that this underutilization is due in large part to misperceptions on the part of health care professionals regarding the risks, benefits, and potential advantages of the ␤-blocker class of agents. The goals of this educational symposium are to review the background and development of ␤-blockers, to update physicians on the benefits and risks of this class, and to assess the emerging distinctions among agents within the class based on pharmacologic differences. Educational Objectives Upon completion of this activity, participants should be able to: ● ● ● ● Review the importance of ␤-blockade in the treatment of hypertension and cardiovascular disease Compare the pharmacologic differences among the various ␤-blocker agents and discuss the potential clinical implications of these differences with regard to efficacy and tolerability Assess accurately the potential benefits and risks associated with the use of various ␤-blockers, in a wide range of patients, based on clinical trial evidence Describe the role of endothelium-derived nitric oxide in endothelial dysfunction and the atherosclerotic process Accreditation and Designation Statements The American Society of Hypertension, Inc. is accredited by the Accreditation Council for Continuing Medical Ed0895-7061/05/$30.00 PIIhttps://academic.oup.com/ajh/article-abstract/18/S6/184S/204263 S0895-7061(05)01232-X Downloaded from by guest on 27 April 2018 ucation (ACCME) to provide continuing medical education for physicians. The American Society of Hypertension, Inc. designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity. Supported by an educational grant from Mylan Laboratories Inc. Disclosure Policy The American Society of Hypertension, Inc. (ASH) strives to insure balance, independence, objectivity, and scientific rigor in all of its educational activities. All participants in such activities are expected to disclose to the program audience any real or apparent conflict(s) of interest that may have a direct bearing on the subject matter of the session in which they are participating. This pertains to relationships, in place at the time of the activity or in the twelve (12) months preceding the activity, with pharmaceutical companies, biomedical device manufacturers, or other corporations whose products or services are related to the subject matter of the presentation topic. Speakers are also expected to openly disclose any off-label, experimental, or investigational use of drugs or devices in their presentations. Faculty Disclosures John R. Cockcroft, MD, FRCP Grants/Research Support: AstraZeneca Pharmaceuticals Consultant: Mylan Pharmaceuticals Norman K. Hollenberg, MD, PhD Grants/Research Support and Consultant: AstraZeneca Pharmaceuticals; Bristol-Myers Squibb Company; GlaxoSmithKline; Metafoods; Novartis Pharmaceuticals Corporation; Pfizer Inc. Michael A. Weber, MD Consultant and Speakers’ Bureau: Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Sankyo Pharma, Inc.; Sanofi-Synthelabo, Inc. © 2005 by the American Journal of Hypertension, Ltd. Published by Elsevier Inc. THE ROAD AHEAD WITH ␤-BLOCKERS 185S AJH–December 2005–VOL. 18, NO. 12 THE ROAD AHEAD WITH ␤-BLOCKERS: EXPANDING TREATMENT OPTIONS IN CARDIOVASCULAR DISEASE CME ASSESSMENT TEST QUESTIONS Instructions: 1) 2) 3) 4) Read the articles carefully. Note the correct response to each question on the Answer Sheet. Complete the Evaluation Form. To receive credit for 2 hours of CME credit, return the completed Answer Sheet and Evaluation Form by e-mail () or fax (212-3568333). Please keep a copy of the forms for your files. Please circle the correct answer for each question on the answer sheet provided at the end of this section. 1. 2. 3. Dr. Raymond P. Ahlquist made his most wellknown contribution to the discovery and study of ␤-blockers by establishing that: a. Catecholamines play an important role in regulating blood pressure. b. Certain chemicals could selectively antagonize adrenergic response at the ␤-receptor. c. Adrenergic-receptor sites could be classified into two groups, which Dr. Ahlquist named “alpha” and “beta.” d. Adrenergic-receptor–blocking agents vary in potency. e. Sympathomimetic amines induce responses similar to those of adrenergic activation. Use of pronethalol, the first ␤-blocker used in humans, demonstrated that ␤-blockade could achieve which of the following in some patients? a. Reduce pain associated with angina pectoris b. Reverse cardiac arrhythmia due to digitalis c. Lower heart rate in patients with supraventricular and ventricular tachycardias d. All of the above e. A and C only Which pharmacologic property of propranolol has been hypothetically linked with the relatively high propensity of this agent to both cause depression and suppress anxiety? a. Intrinsic sympathomimetic activity b. Hydrophilicity c. ␣-blockade 4. 5. 6. 7. d. Lipophilicity e. ␤-blockade Among the eight FDA-approved indications for ␤-blockers are included: a. Hypertension b. Reversing left ventricular hypertrophy c. Heart failure d. All of the above e. A and C only Underutilization of ␤-blockers by health care professionals may be attributed to: a. Individual case reports or observational, nonrandomized data on adverse events occurring with ␤-blockers. b. Substantial data from randomized, placebocontrolled trials showing that ␤-blockers are associated with significantly increased adverse event rates. c. Substantial data from meta-analyses showing that ␤-blockers are associated with increased overall rates of adverse events, compared to other antihypertensive agents. d. All of the above. e. A and B only. The hypothesized mechanisms of action shared by all ␤-blockers include: a. Suppression of sympathetic nervous system activation b. Inhibition of renin release from the kidney c. Slowing of heart rate d. All of the above e. A and C only Which of the following is an accurate statement regarding the various properties of the ␤1-, ␤2-, and ␣1-adrenergic receptors? a. The relative (...truncated)