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Prenalterol as long-term therapy for chronic congestive heart failure. A randomized cross-over trial
Insights
Prenalterol, a beta-receptor agonist, offered subjective relief for severe chronic heart failure patients but lacked objective benefits over intensified diuretic therapy. Exercise heart rate was lower with prenalterol, suggesting a beta-blocking effect during exertion.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Severe chronic congestive heart failure (CHF) poses significant challenges in patient management.
- Ischaemic heart disease is a common etiology for severe CHF, often managed with digitalis and diuretics.
Purpose of the Study:
- To evaluate the efficacy of prenalterol as an adjunct therapy in severe chronic congestive heart failure.
- To compare prenalterol's effects against intensified conventional diuretic treatment in a cross-over trial.
Main Methods:
- A randomized cross-over trial involving ten patients with severe CHF due to ischaemic heart disease.
- Patients received oral prenalterol (100-200 mg daily) or intensified diuretic treatment, with a 1-4 week wash-out period.
- Objective assessments included exercise tests, echocardiography, chest X-ray, and weight measurements.
Main Results:
- Most patients reported subjective improvement with prenalterol, but objective measures showed no significant difference compared to intensified diuretics.
- Prenalterol significantly lowered heart rate during exercise, indicating a beta-adrenergic receptor blocking effect in this context.
- No serious adverse events were noted for either treatment regimen.
Conclusions:
- Prenalterol, a partial beta-receptor agonist, did not demonstrate superior benefits over intensified conventional treatment for severe chronic CHF.
- The observed reduction in exercise heart rate suggests a beta-blocking action during physical exertion in CHF patients.
Abstract:
Ten patients with severe chronic congestive heart failure (CHF) due to ischaemic heart disease treated with digitalis and diuretics were randomly allocated to oral treatment with prenalterol (100-200 mg daily in addition to their basal treatment) or to intensified treatment with diuretics in a cross-over trial. A wash-out period of 1-4 weeks was allowed between the two modes of treatment. Most of the patients demonstrated subjective improvement during prenalterol therapy, but this improvement could not be verified objectively by exercise test, echocardiography, chest X-ray or weight measurements. No serious side-effects of either mode of treatment were observed. Heart rate was significantly lower during exercise when the patients were treated with prenalterol than during the control periods or during intensified conventional treatment, indicating that prenalterol acts as a beta-adrenergic receptor blocker during exercise in this patient group. The results indicate that prenalterol is a partial beta-receptor agonist without superior beneficial effects compared to those of intensified conventional treatment in patients with chronic, severe CHF.