The effects of alpha and beta blockade on ventilatory responses to exercise in chronic heart failure.
OBJECTIVE
To assess the influence of acute alpha and beta blockade on ventilation and symptoms of breathlessness during exercise in patients with chronic heart failure and in controls.


METHODS
11 patients with chronic heart failure and 11 control subjects underwent repeated exercise testing with metabolic gas exchange after random, double blind administration of either an alpha blocker and placebo, a beta blocker and a placebo, both an alpha blocker and a beta blocker, or double placebo.


RESULTS
Patients had a lower peak oxygen consumption (mean (SD) 20.7 (4.9) v 37.6 (9.6) ml/kg/min, p < 0.0001) and a steeper slope relating ventilation to carbon dioxide production (VE/CO2 slope) (26.5 (4.1) v 37.1 (8.2), p = 0.0011), than controls. Blood pressure was lower following alpha and beta blockade (p < 0.05) and the gradients of the slopes relating heart rate to oxygen consumption following the beta blocker were reduced (p < 0.05). Exercise time and peak ventilatory variables following beta or alpha blockers were unchanged. Ventilation was reduced during submaximal exercise following the active medications. Combined alpha and beta blockade produced the greatest difference (p < 0.005), but the alpha and beta blockers alone also reduced ventilation (p < 0.05). There was no difference in perceived exertion during exercise with any of the treatments.


CONCLUSIONS
Acute sympathetic inhibition can reduce submaximal ventilation during exercise in patients with heart failure and control subjects, suggesting that autonomic nervous system activation has an important role in the abnormal ventilatory response to exercise in chronic heart failure.
Witte
K K A
KK
Academic Cardiology, Castle Hill Hospital, Castle Road, Cottingham, Hull, UK. klauswitte@hotmail.com
Thackray
S D R
SD
Nikitin
N P
NP
Cleland
J G F
JG
Clark
A L
AL
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002303:Cardiac Output, Low / Q000150:complications / Q000503:physiopathology*; D002908:Chronic Disease; D004311:Double-Blind Method; D017292:Doxazosin / Q000627:therapeutic use*; D004417:Dyspnea / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005541:Forced Expiratory Volume / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D010101:Oxygen Consumption; D012120:Respiration Disorders / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D008790:Metoprolol; D017292:Doxazosin