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Renal and cardiac function during alpha1-beta-blockade in congestive heart failure

M Heitmann1, U Davidsen, K H Stokholm

  • 1Department of Internal Medicine, Roskilde Hospital, Denmark. m.heitmann@dadlnet.dk

Scandinavian Journal of Clinical and Laboratory Investigation
|May 15, 2002
PubMed

Insights

Adding carvedilol to standard congestive heart failure (CHF) treatment improved cardiac function and neurohormonal markers. While blood pressure and heart rate decreased, renal function showed only a minor drop in glomerular filtration rate (GFR), emphasizing monitoring needs.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Congestive heart failure (CHF) involves kidney and neurohormonal systems.
  • Standard CHF treatment includes diuretics, ACE inhibitors, and beta-blockers.
  • Renal function monitoring is crucial during ACE inhibitor therapy for CHF.

Purpose of the Study:

  • To evaluate if combined alpha1-beta-blockade (carvedilol) with diuretics and ACE inhibitors improves cardiac function without impairing renal function.
  • To assess the impact of carvedilol on hemodynamics, cardiac function, and renal parameters in CHF patients.

Main Methods:

  • Fourteen patients with moderate to severe CHF on diuretics and ACE inhibitors were studied.
  • Carvedilol was administered for 4 months, followed by withdrawal.
  • Measurements included cardiac function, blood pressure, heart rate, and renal function (GFR, renal blood flow, effective renal plasma flow).

Main Results:

  • Carvedilol reduced blood pressure and heart rate, increasing ventricular ejection fractions.
  • Cardiac output and pulmonary blood volume remained unchanged.
  • Glomerular filtration rate (GFR) slightly decreased, but renal blood flow was stable and effective renal plasma flow increased.
  • Plasma levels of angiotensin II and aldosterone were reduced.

Conclusions:

  • Carvedilol enhances ACE inhibitor effects by lowering blood pressure and angiotensin II levels, and reducing heart rate.
  • Cardiac adaptation occurred without altering cardiac output or pulmonary blood volume.
  • Despite minimal renal changes, careful renal function monitoring is advised during carvedilol treatment in CHF patients.
Abstract

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