@article{ref1,
title="Pre-injury beta blocker use does not affect the hyperdynamic response in older trauma patients",
journal="Journal of emergencies, trauma and shock",
year="2014",
author="Evans, David C. and Khoo, Kendrick M. and Radulescu, Andrei and Cook, Charles H. and Gerlach, Anthony T. and Papadimos, Thomas J. and Steinberg, Steven M. and Stawicki, Stanislaw Pa and Eiferman, Daniel S.",
volume="7",
number="4",
pages="305-309",
abstract="PURPOSE: Trauma dogma dictates that the physiologic response to injury is blunted by beta-blockers and other cardiac medications. We sought to determine how the pre-injury cardiac medication profile influences admission physiology and post-injury outcomes. <br><br>MATERIALS AND METHODS: Trauma patients older than 45 evaluated at our center were retrospectively studied. Pre-injury medication profiles were evaluated for angiotensin-converting enzyme inhibitors / angiotensin receptor blockers (ACE-I/ARB), beta-blockers, calcium channel blockers, amiodarone, or a combination of the above mentioned agents. Multivariable logistic regression or linear regression analyses were used to identify relationships between pre-injury medications, vital signs on presentation, post-injury complications, length of hospital stay, and mortality. <br><br>RESULTS: Records of 645 patients were reviewed (mean age 62.9 years, Injury Severity Score >10, 23%). Our analysis demonstrated no effect on systolic and diastolic blood pressures from beta-blocker, ACE-I/ARB, calcium channel blocker, and amiodarone use. The triple therapy (combined beta-blocker, calcium channel blocker, and ACE-I/ARB) patient group had significantly lower heart rate than the no cardiac medication group. No other groups were statistically different for heart rate, systolic, and diastolic blood pressure. <br><br>CONCLUSIONS: Pre-injury use of cardiac medication lowered heart rate in the triple-agent group (beta-blocker, calcium channel blocker, and ACEi/ARB) when compared the no cardiac medication group. While most combinations of cardiac medications do not blunt the hyperdynamic response in trauma cases, patients on combined beta-blocker, calcium channel blocker, and ACE-I/ARB therapy had higher mortality and more in-hospital complications despite only mild attenuation of the hyperdynamic response.<p /> <p>Language: en</p>",
language="en",
issn="0974-2700",
doi="10.4103/0974-2700.142766",
url="http://dx.doi.org/10.4103/0974-2700.142766"
}