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The Effect of Beta-blockade on Objectively Measured Physical Fitness in Patients With Abdominal Aortic Aneurysms

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A Blinded Interventional Study

Authors: M. A. West et al

Br J Anaesth. 2015;114(6):878-885.

Background: Perioperative beta-blockade is widely used, especially before vascular surgery; however, its impact on exercise performance assessed using cardiopulmonary exercise testing (CPET) in this group is unknown. We hypothesized that beta-blocker therapy would significantly improve CPET-derived physical fitness in this group.

Methods: We recruited patients with abdominal aortic aneurysms (AAA) of <5.5 cm under surveillance. All patients underwent CPET on and off beta-blockers. Patients routinely prescribed beta-blockers underwent a first CPET on medication. Beta-blockers were stopped for one week before a second CPET. Patients not routinely taking beta-blockers underwent the first CPET off treatment, then performed a second CPET after commencement of bisoprolol for at least 48 h. Oxygen uptake (V̇O2) at estimated lactate threshold and V̇ O2 at peak were primary outcome variables. A linear mixed-effects model was fitted to investigate any difference in adjusted CPET variables on and off beta-blockers.

Results: Forty-eight patients completed the study. No difference was observed in V̇O2 at and V̇ O2 at peak; however, a significant decrease in V̇ E/V̇ CO2 at and peak, an increase in workload at O 2 pulse and heart rate both at and peak was found with beta-blockers. Patients taking beta-blockers routinely (chronic group) had worse exercise performance (lower V̇ O2).

Conclusions: Beta blockade has a significant impact on CPET-derived exercise performance, albeit without changing V̇O2 at and V̇ O2 at peak. This supports performance of preoperative CPET on or off beta-blockers depending on local perioperative practice.

 

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