More importantly, we could demonstrate that discontinuation of beta-blocker therapy during hospitalization selleckbio is associated with higher mortality rates, suggesting a protective effect of beta-blocker therapy in our acute respiratory failure patients. Discontinuation of beta-blocker therapy is indeed associated with a “withdrawal syndrome”, a transient sympathetic hyper-response caused by hypersensitivity of cardiac ��-receptors [18]. Patients in whom beta-blockers were discontinued complained of transient palpitations, tremor, sweating, headache and general malaise. A significant increase in blood pressure and heart rate could also be demonstrated 24 h after beta-blocker withdrawal [19]. A survival benefit of continuation of beta-blocker therapy in patients with ADHF was demonstrated by Butler et al.

[20] and recently confirmed by Fonarow et al. [21], Jondeau et al. [22] and Orso et al. [23]. There is, furthermore, evidence that patients admitted with AECOPD may also benefit from continuation of beta-blocker therapy [24]. The observed positive association of beta-blocker continuation with lower mortality may be explained by the prevention of malignant ventricular arrhythmias, protection against myocardial infarction or acute negative mechanical remodeling, which may initiate the development of fatal pump failure [23,25].In our study, treatment with beta-blockers at discharge was associated with lower one-year mortality. There is solid evidence showing that oral treatment with beta-blockers improves long-term survival in various cardiovascular diseases including CHF, CAD or arterial hypertension [26-29].

A recently published, large observational cohort study demonstrated that treatment with beta-blockers also reduce risk of exacerbations and improve survival in patients with COPD [30]. Interestingly, this effect was shown to be independent of cardiovascular co-morbidities. Beta-blockers are known to temper the sympathetic nervous system, including the reduction of heart rate. Therefore, negative systemic effects in the disease progression of cardiovascular disease including CAD, CHF or arterial hypertension, as well as COPD [31] could be diminished. Heart rate reduction itself may be an important mechanism of the benefit of beta-blockers. Large epidemiological studies have shown that resting heart rate was an independent predictor of all-cause mortality in individuals with and without cardiovascular disease [24].Angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) and beta-blockers build the mainstay of therapy in patients with CHF and/or CAD with impaired left Entinostat ventricular function [32]. In our study, treatment with ACEi/ARB was also associated with improved one-year survival.