Microsoft word - aas2009abstrcoreg.doc

American Autonomic Society Abstract
St. Thomas, Virgin Islands
31 Oct – 3 Nov, 2009
Submitted: 31 May 2009
Accepted: 6 Aug 2009 – Poster #76
Category: Pharmacology and Treatment
Abstract #751
Carvedilol Reverses Standing Parasympathetic Excess in Non-
Diabetics
Rohit R. Arora, MD; Robert J Bulgarelli, DO; Marty Hearyman, MD; Sam Gosh Dastidar,
PhD; Joe Colombo, PhD
Introduction: There is a segment of the patient population that present with beta-blocker on
board and with difficult to control BP, or blood sugars in diabetics, or hormone levels in
hypothyroid or menopausal patients. They also present with fatigue or exercise intolerance,
depression-like symptoms, sleep difficulties, GI upset, or frequent headache or migraine. The
established need for a beta-blocker indicates a previous or continued sympathetic excess. The
additional symptoms are associated with parasympathetic excesses that occur during sympathetic
challenges in a standard autonomic study (Valsalva and Stand). Anti-cholinergic therapy to
address the additional symptoms is contra-indicated given the need for the beta-blocker.
Carvedilol was administered in place of the beta-blocker to address these additional symptoms.
Methods: Serial ANS assessments were administered to 238 Patients (145 Female, 60.8%;
averages: 60.1±12.0 years; 63.3±3.8 inches; 150.4±36.7 pounds) in 12 ambulatory clinics. ANS
assessment was performed with the ANX-3.0 (ANSAR Medical Technologies, Inc.,
Philadelphia, PA) and included five minutes of rest and a quick stand followed by five minutes
of quiet standing. HR variability analysis concurrent with respiratory activity analysis was
performed to independently and simultaneously compute sympathetic (LFa) and parasympathetic
(RFa) activity throughout the phases of the ANS study. Results: Patients, on average, were well
maintained at rest. They presented with (see Table) low normal HR, normal BP), normal
sympathetic activity (LFa), low-normal parasympathetic activity (RFa), and normal
sympathovagal balance (LFa/Rfa). Upon standing they presented with normal sympathetic
responses (an increase from rest), but abnormal parasympathetic responses (an increase from
rest). These patients were switched from their beta-blocker to dose equivalent or lower
Carvedilol (6.25mg bid on average) and retested 4.1±1.1 months later. Their resting responses
remained normal, but sympathovagal balance became low-normal which indicating extra
parasympathetic activity as recommended to minimize morbidity and mortality. Their stand
responses were normalized. The stand sympathetic response was reduced, yet remained normal
and the stand parasympathetic response was corrected from the abnormal increase to the normal
decrease. Clinically, patients reported less fatigue or exercise intolerance, improvements in sleep
habits (falling asleep in under 20 minutes and fewer waking episodes during the night), a reduced
dependency on any prescribed anti-depressants, reduced GI upset, and fewer headache or
migraine. Conclusion: The two agents included in Carvedilol seems to provide additional
benefits for non-diabetics requiring a beta-blocker.
Resting Sympathetics (bpm2) 1.10±0.7 0.63±0.2 Resting Parasympathetics

Source: http://www.ans-hrv.com/AAS2009AbstrCoreg.pdf