CSP #2026 - Beta Blocker Dialyzability on Cardiovascular Outcomes (BRAVO)
VA Office of Research and Development
Summary
The investigators aim to determine, using a point-of-care randomized controlled trial design, if hemodialysis patients, who are randomized to metoprolol succinate (a dialyzable, beta-1 selective beta blocker), have an improved cardiovascular outcome compared to those randomized to carvedilol (a non-dialyzable, non-selective beta blocker with alpha-1 antagonist properties). The investigators will also examine intervention practices to identify components that best support engagement and sustainability.
Description
Approximately 35,000 Veterans have end stage kidney disease (ESKD) with an incidence of 13,000 annually. These numbers are increasing because of the epidemic of diabetes, the most common cause of ESKD, among the Veteran population. Patients with ESKD on hemodialysis have substantial cardiovascular morbidity. Veterans annual mortality is in excess of 15% and more than half the deaths are due to cardiovascular disease. Beta blockers have been shown to prevent cardiovascular events in randomized clinical trials in patients without chronic kidney disease, particularly those with heart failure and…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * On hemodialysis * Received one of the following beta blockers through the VA pharmacy: metoprolol (succinate or tartrate), atenolol, labetalol, carvedilol, bisoprolol Exclusion Criteria: * Impaired decision-making capacity * Patients not receiving carvedilol who have a history of asthma * known hypersensitivity to any component of either drug * Provider unwilling to sign a new medication order for a randomized patient * No surrogate consent will be allowed
Interventions
- DrugMetoprolol Succinate
a dialyzable, beta-1 selective beta blocker
- DrugCarvedilol
a non-dialyzable, non-selective beta blocker with alpha-1 antagonist properties
Locations (8)
- VA Long Beach Healthcare System, Long Beach, CALong Beach, California
- North Florida/South Georgia Veterans Health System, Gainesville, FLGainesville, Florida
- Atlanta VA Medical and Rehab Center, Decatur, GADecatur, Georgia
- Iowa City VA Health Care System, Iowa City, IAIowa City, Iowa
- VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MABoston, Massachusetts
- Minneapolis VA Health Care System, Minneapolis, MNMinneapolis, Minnesota