Cardiovascular Club I 11:00 AM Thursday, February 25, 2010
1 BETA-BLOCKING DRUG USE IN COCAINE ABUSERS: IS IT SAFE AND EFFECTIVE THERAPY IN HOSPITALIZED PATIENTS?
GD. Everett1, N. Uddin2, A. Java3, A. Klotchko3, A. Velazquez3, S. Singapuri3, A. Prevost3, R. Rostorfer3, E. Benzaquen3, K. Patel3, V. Patel3, P. Fotso3, L. Ramos3 1Florida Hospital Medical Center, Orlando, FL; 2University of Central Florida, Orlando, FL and 3Orlando Health, Orlando, FL.
Purpose of Study: Case reports have suggested that beta-blockers may unpredictably exacerbate hypertension and tachycardia in concurrent cocaine abusers. Physicians avoid beta-blockers in these patients despite the chest pain and hypertension that cocaine may cause. This study was designed to assess the physiological effect of beta-blockers given to cocaine abusers during emergency room and hospital stays when their symptoms warrented beta-blockers but before their use of cocaine was discovered.
Methods Used: A cohort consisting of every patient admitted to a large, urban hospital during a single calendar year, whose urine contained cocaine metabolites, was created. Subjects were included if they had blood pressure and heart rate measurements recorded before and after beta-blockers or other medications were given. 114 subjects met the criteria. Multivariate regression analysis was used to assess the independent effect of beta-blockers on the blood pressure and heart rate. The regression analysis controlled for the effect of each vasoactive medication given to the subjects.
Summary of Results: The subjects were 33% female, 64% black, 27% white and 9% other race. The median age was 43(23-74). Chest pain (30%) was the most common admission complaint. 5% of subjects had a troponin level of more than 1.0. 14% and 4% of subjects had creatinine values that exceeded 3.0 and 9.0 respectively. The table displays the results of the main analysis: unadjusted and multivariate adjusted effects of beta-blockers on …