Metoprolol succinate extended release tablets (50 mg) starting dose followed by a dose titration procedure which will result in a final dose of 25mg (1/2 of one tablet daily), 50 mg, or 100 mg (two tablets daily).

Pulmonary Disease, Chronic Obstructive

Metoprolol succinate

Placebo

Birmingham, Alabama VA Medical

University of Alabama at Birmingham

University of California, San Francisco-Fresno

LA BioMed at Harbor-UCLA Medical Center

University of California at San Francisco

National Jewish Medical & Research Center

North Florida/South Georgia Veterans Health System

Northwestern University

Louisiana State University

University of Maryland Baltimore

Brigham and Women's Hospital

VA Ann Arbor Healthcare System

University of Michigan

Veteran's Administration Medical Center

HealthPartners Research Foundation

Mayo Clinic

NewYork-Presbyterian Brooklyn Methodist Hospital

New York Presbyterian/Queens

Cornell University

Columbia University

Cincinnati VA Medical Center

Cleveland Clinic

Temple University Lung Center

University of Pittsburgh

University of Utah Health Sciences Center

The University of Vermont

University of Washington School of Medicine

Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Beta-Blockers for the Prevention of Acute Exacerbations of COPD

Acute exacerbations are defined as a "complex of respiratory symptoms (increase or new onset) of more than one of the following: cough, sputum, wheezing, dyspnea, or chest tightness requiring treatment with antibiotics and/or systemic steroids for at least three days".

Number of Emergency Department visits resulting from acute exacerbations of COPD

Number of hospital admissions resulting from acute exacerbations of COPD

Number of hospital days resulting from acute exacerbations of COPD

MACE defined by cardiovascular death, hospitalization for myocardial infarction, heart failure, or stroke

New or worsened (Neural: depression, headache, syncope, seizures, somnolence, memory loss, loss of sexual desire or erectile dysfunction, and fatigue; Hypersensitivity: rash, pruritus, tongue or facial swelling; Gastrointestinal: diarrhea, vomiting, nausea or constipation; Cardiovascular: bradycardia and hypotension as discussed below; Respiratory: bronchospasm and changes in lung function as discussed below).

SF-36 is a generic tool to assess overall health status and allows comparison between different diseases.

The MMRC scale is a five-point scale originally published in 1959 that considers certain activities, such as walking or climbing stairs, which provoke breathlessness.

The 6MWD has been used as a simple tool to assess overall exercise tolerance in patients with chronic cardiopulmonary disease including COPD.

troponin-I, pro-NT Brain Natriuretic Peptide, high sensitivity C-reactive protein, and fibrinogen: These parameters will be assessed at screening/randomization and at conclusion of the study to determine if beta-blockade impacts volume status and cardiac performance as well as levels of systemic inflammation that portend overall cardiac risk.

The SGRQ is a respiratory specific health status questionnaire with scores ranging from 0 to 100. The lower score indicates a better health status.

The CAT is a simple, eight item, health status instrument for patients with COPD. Lower scores denote better health status.

A 24-item measure that assesses self-reported shortness of breath while performing a variety of activities of daily living.

University of Minnesota

United States Department of Defense

nebivolol 1 to 4 capsules daily
nebivolol: Study medication will initially be dispensed as one capsule daily and the dose will be titrated at the study visits. Nebivolol is approved for hypertension treatment at a dose of 5-40 mg daily. Based on the study titration schedule, the maximum doses used will be 20 mg of nebivolol (each maximum dose being contained in 4 capsules for daily dosing).

Nebivolol

metoprolol 1 to 4 capsules daily
Metoprolol succinate: Study medication will initially be dispensed as one capsule daily and the dose will be titrated at study visits. Metoprolol succinate at 25-400 mg daily. Based on the study titration schedule, the maximum dose used will be 200 mg of metoprolol succinate (each maximum dose being contained in 4 capsules for daily dosing).

Metoprolol Succinate

Total

Sex: Female, Male

Ethnicity (NIH/OMB)

Race (NIH/OMB)

Region of Enrollment

Change in peak walking time (PWT) is measured in seconds. The PWT is defined as when walking on a treadmill cannot continue due to maximal leg pain, resulting in the discontinuation of the treadmill test.

Peak Walking Time (PWT)

Change in measurement of Ankle-brachial index (ABI). The ABI is the ratio of the blood pressure measured in the lower legs to the blood pressure measured in the arms.

Ankle-brachial Index (ABI)

Change in measurement of claudication onset time (COT). The COT is defined as the time when a patient first experienced pain walking during a treadmill test.

Claudication Onset Time (COT)

Change in calf pain as captured by the Walking Impairment Questionnaire (WIQ). A 5 point Likert scale scoring ranges from 1) No Difficulty, 2) Slight Difficulty, 3) Some Difficulty, 4) Much Difficulty, and 5) Great Difficulty. The scores are determined by dividing the score by the maximum possible score and then multiplying by 100. The score ranges from 0-100 with lower scores indicating greater pain.

Walking Impairment Questionnaire (WIQ) - Change Calf Pain

Change in buttock pain as captured by the Walking Impairment Questionnaire (WIQ). A 5 point Likert scale scoring ranges from 1) No Difficulty, 2) Slight Difficulty, 3) Some Difficulty, 4) Much Difficulty, and 5) Great Difficulty. The scores are determined by dividing the score by the maximum possible score and then multiplying by 100. The score ranges from 0-100 with lower scores indicating greater pain.

Walking Impairment Questionnaire (WIQ) - Change in Buttock Pain

Change in distance score as captured by the Walking Impairment Questionnaire (WIQ) distance score subscale. The degree of difficulty in the walking of specific distances is ranked on a 0 to 4 Likert scale, in which 0 represents the inability to walk the distance and 4 represents no difficulty. A Likert scale is an ordinal scale of consecutive, equidistant, numerical values (ie, 0 to 4). The distances assessed in the WIQ range from walking indoors around the home to walking 5 blocks (1500 feet). The items on the subscale are weighted according to the difficulty of walking. The distance score is determined by dividing the total weighted score by the greatest possible weighted score and multiplying by 100. Scores range from 0-100.

Walking Impairment Questionnaire (WIQ) - Change in WIQ Distance Score

Change in speed score as captured by the Walking Impairment Questionnaire (WIQ) speed score subscale. In the walking speed component, the degree of difficulty walking is ranked on a 0 to 4 scale where speed is assessed for each of the following speeds: at the following speeds: 1, slowly; 2, average speed; 3, quickly; or 4, running or jogging 1 block. Zero represents the inability to walk the specified speed, and 4 represents no difficulty. The items on the subscale are weighted according to the difficulty of the task. The speed score is determined by dividing the total weighted score by the greatest possible weighted score and multiplying by 100. Scores range from 0-100.

Walking Impairment Questionnaire (WIQ) - Change in WIQ Speed Score

Change in stairs score as captured by the Walking Impairment Questionnaire (WIQ) stairs subscale. This scale item asks the subject to describe the degree of difficulty climbing one, two, or three flights of stairs in the past week. A flight of stairs is defined as 14 steps. A 5 point Likert scale scoring ranges from 1) No Difficulty, 2) Slight Difficulty, 3) Some Difficulty, 4) Much Difficulty, 5) Unable to Do, or 6) Didn Do for Other Reasons. The items on the subscale are weighted according to the difficulty of the task. The stairs score is determined by dividing the total weighted score by the greatest possible weighted score and multiplying by 100. Scores range from 0-100.

Walking Impairment Questionnaire (WIQ) - Change in WIQ Stairs Score

Overall Study

Danielle Duffy MD

Peripheral Artery Disease

Hypertension

Study medication will initially be dispensed as one capsule daily and the dose will be titrated at the study visits. Nebivolol is approved for hypertension treatment at a dose of 5-40 mg daily. Based on the study titration schedule, the maximum doses used will be 20 mg of nebivolol (each maximum dose being contained in 4 capsules for daily dosing).

nebivolol

Study medication will initially be dispensed as one capsule daily and the dose will be titrated at study visits. Metoprolol succinate at 25-400 mg daily. Based on the study titration schedule, the maximum dose used will be 200 mg of metoprolol succinate (each maximum dose being contained in 4 capsules for daily dosing).

Thomas Jefferson University

Comparison of 2 Beta Blocker Drugs on Peripheral Arterial Disease in Patients With High Blood Pressure

Effect of Nebivolol Compared With Metoprolol in Hypertensive Patients With Peripheral Arterial Disease

Forest Laboratories

Phenoxybenzamine (capsules 10 mg, once to twice daily) is administered orally, starting 2-3 weeks before planned resection of PCC.

Phenoxybenzamine (slow release tablets 4 or 8 mg, once to twice daily) is administered orally, starting 2-3 weeks before planned resection of PCC.

Pheochromocytoma

Starting dosage of phenoxybenzamine in hypertensive subjects:20 mg q.d. (=10 mg b.i.d.) and in normotensive subjects 10 mg q.d. (in the evening). Dose escalation until blood pressure targets are reached, with a maximum dose of 140 mg q.d. (=70 mg b.i.d.)

Phenoxybenzamine

Starting dosage of doxazosine in hypertensive subjects:8 mg q.d. (=4 mg b.i.d.)and in normotensive subjects starting dose 4 mg q.d. (in the evening). Dose escalation until blood pressure targets are reached, with a maximum dose of 48 mg q.d. .(=24 mg b.i.d.)

Doxazosin

Department of Endocrinology, University Medical Center Groningen

Phenoxybenzamine Versus Doxazosin in PCC Patients

Pheochromocytoma Randomised Study Comparing Adrenoreceptor Inhibiting Agents for Preoperative Treatment

Blood pressure and heart rate will be monitored continuesly during surgery.

success rate of doxazosin and phenoxybenzamine to attain preoperative blood pressure target values without co-medication

Resulution of headache, palpitations, sweeting, paleness, nausea, flushes, fatigue and anxiety.

Assessment of the number of patients who need additional antihypertensive drugs on top of the study drugs

Adverse effects of doxazosin or phenoxybenzamine

Comparing duration of preoperative treatment in either outpatient or inpatient clinic

number of episodes with systolic blood pressure (SBP) > 160 mmHg
number of episodes with mean arterial blood pressure (MAP) < 60 mmHg
duration (in minutes) of SBP > 160 mmHg
duration (in minutes) of MAP < 60 mmHg
number of episodes with heart rate > 100/min
duration (in minutes) of heart rate > 100/min
amount and type of vasoactive agents needed during surgery for adequate blood pressure control.
cumulative amount and type of intravenous fluids administered

Number of days the patient is staying in the hospital before and after surgery

Composite semi-quantitative score of intra- and postoperative hemodynamic control based on the following parameters:
blood pressure and heart rate outside target range
need for administration of vasoactive agents
need for administration of intravenous fluids

Frequency and severity (in mmol/L)of hypoglycaemia during first 24 hours after surgery.

Death from any cause occurring during period from first administration of study medication until 30 days after surgery.

Cardiovascular events occurring during period from first administration of study medication until 30 days after surgery. Cardiovascular events are: myocardial infarction, cardiac arrhythmia requiring medical intervention, heart failure, cerebrovascular ischemia, cerebrovascular haemorrhage.

Death from any cause occurring or cardiovascular events occurring during period from first administration of study medication until 30 days after surgery.

succinate/infarkts

Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Comparison of 2 Beta Blocker Drugs on Peripheral Arterial Disease in Patients With High Blood Pressure

Phenoxybenzamine Versus Doxazosin in PCC Patients

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