TITLE

β-Blockers in Heart Failure: The ‘New Wave’ of Clinical Trials

AUTHOR(S)
Krum, H.
PUB. DATE
August 1999
SOURCE
Drugs;Aug1999, Vol. 58 Issue 2, p203
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
There is now considerable clinical trial data to support the use of β-blockers in patients with congestive heart failure (CHF) due to systolic left ventricular dysfunction. A substantial database has accumulated over the last 20 years supporting the benefits of these agents on ventricular function and clinical status. In addition, morbidity and mortality benefits have been suggested, specifically with the non-selective vasodilating agent, carvedilol. More recently, a “new wave” of clinical trials have been conducted to definitively determine the mortality benefits of β-blockers in patients with mild to moderate CHF as well as addressing other important clinical questions. These questions include whether the beneficial effects of carvedilol on survival can be reproduced by other agents in prospective, adequately powered studies; whether the benefits of carvedilol in systolic heart failure are due to its β-blocking properties alone or to a combination of the β-blocking and ancillary effects of the drug; whether β-blockers are of benefit in patients with severe New York Heart Association (NYHA) Class IIIB-IV CHF; and, whether β-blockers are of benefit (additional to ACE inhibitors) in patients with evidence of systolic ventricular dysfunction when commenced in the immediate post-myocardial infarction period. Major studies are currently being undertaken to address the above questions. Most are still underway but 3 studies have recently reported their results: the second Cardiac Insufficiency Bisoprolol Study (CIBIS II), the Research in Left Ventricular Dysfunction Study (RESOLVD), and the Metoprolol CR/XL Randomised Intervention Trial in Heart Failure (MERIT-HF) study. These studies have demonstrated that blockade with β-selective, non-vasodilating agents (i.e. bisoprolol and metoprolol) improve survival in patients with CHF. Comparison of relative risk reduction in these recent studies with the earlier carvedilol studies raises mechanistic questions, specifically whether non-selectivity, vasodilation and other ancillary properties of carvedilol are critical to its benefit in CHF patients. This question is currently being addressed in the Carvedilol and Metoprolol European Trial (COMET), comparing metoprolol with carvedilol. The beneficial effects of β-blockers on mortality in patients with mild to moderate CHF have also had major implications in ongoing studies of other agents in this condition. Open-label prescribing of β-blockers is increasing in these studies and this is having an impact on event rates and thus required duration of administration of study drug. Furthermore, it would now appear unethical to deprive suitable NYHA Class II-III CHF patients of β-blockers as part of the design of such studies. In conclusion, β-blockers have now become the most extensively studied class of agents in the treatment of CHF, with a database of over 6000 patients in placebo-controlled studies, and ongoing clinical and mechanistic studies. Despite this, further questions remain regarding the use of these agents in CHF, including their role in the extreme elderly, in patients with diabetes mellitus and in patients with renal impairment.
ACCESSION #
9592867

 

Related Articles

  • MERIT-HF – description of the trial. Wikstrand, J. // Basic Research in Cardiology;Nov2000 Supplement 1, Vol. 95, pI90 

    The MERIT-HF study was a randomized, double-blind, placebo-controlled trial with a single-blind, two-week placebo run-in period. There were two primary objectives: total mortality; and the combined endpoint of total mortality or all-cause hospitalizations (time to first event). Several other...

  • The background of the MERIT-HF trial. Dietz, R.; Osterziel, K.J.; Willenbrock, R.; Hänlein, D.; v.Harsdorf, R. // Basic Research in Cardiology;Nov2000 Supplement 1, Vol. 95, pI84 

    In the not so distant past, the idea of using beta-blockers as a primary therapy for congestive heart failure to improve symptoms and prognosis seemed paradoxical. The cardiac community reacted with skepticism when, in 1975, the pioneering report of Waagstein et al. appeared in the British Heart...

  • Headway in heart failure treatment. van Vlaanderen, Edward // Cortlandt Forum;02/25/99, Vol. 12 Issue 2, p167 

    Reports on three clinical trials which is said to give a promise of establishing a new standard of care in the treatment of congestive heart failure (CHF). Randomized Aldactone Evaluation Study; Cardiac Insufficiency Bisoprolol Study II; Metoprolol CR/XL Randomized Interventional Trial in Heart...

  • Beta-adrenergic blockers in chronic congestive heart failure. Smith, Andrew J.; Manley, Harold J.; Richardson, Antoine D. // American Journal of Health-System Pharmacy;3/1/2002, Vol. 59 Issue 5, p467 

    Comments on a study on beta-adrenergic blockers in chronic congestive heart failure. Review of early beta-blocker studies; Significant reduction reported in the composite end-point of death and hospital admission in Australia/New Zealand Carvedilol Trial.

  • Few CHF patients achieve target dosages of beta blockers, risking hospitalizations and death. Young, David // Formulary;Jun2002, Vol. 37 Issue 6, p321 

    Examines the effect of administering inadequate beta blocker therapy on patients with congestive heart failure (CHF) in Philadelphia, Pennsylvania. Comparison of rates of hospitalization and death with escalating doses of carvedilol; Use of retrospective analysis; Symptoms and diagnosis of CHF....

  • Beta-blockers and CHF: Contraindication, paradox, or breakthrough?  // Patient Care;8/15/1993, Vol. 27 Issue 13, p36 

    Discusses the contradiction in cautious use of beta-blockers in the presence of congestive heart failure. Exacerbation of congestive heart failure; Contradiction in literature; Role in the management of some forms of heart failure; Improvement in the ejection factor.

  • Mending a Broken Heart. Portyansky, Elena // Drug Topics;11/1/99, Vol. 143 Issue 21, p60 

    Talks about treatment for congestive heart failure (CHF). Evidence that CHF has become an epidemic; Causes and result of CHF; Therapeutic advancement in CHF; Advice on how to counsel CHF patients who are being started on a beta-blocker. INSET: Tips to Remember.

  • Managing Progressive CHF in the Elderly. Manzoor, Naila; Steingart, Richard M. // Cortlandt Forum;09/25/99, Vol. 12 Issue 9, p181 

    Highlights the value of beta blockers for elderly patients with congestive heart failure. Major cause of hospitalization in elderly Americans; Evidence of the efficacy of carvelidol in patients with heart failure; Decrease of diuretic requirement.

  • ... and for congestive heart failure.  // Consumer Reports on Health;Nov98, Vol. 10 Issue 11, p10 

    Reports on a study presented at a meeting of the European Society of Cardiology, which adds to the evidence that beta-blocker drugs can also reduce the risk of death in patients with mild to moderate heart failure by slowing the progression of the disease and reversing some cardiac damage.

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics