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Vasodilating beta-blockers in heart failure

E B Raftery1

  • 1MRC Division of Cardiovascular Diseases, Northwick Park Hospital and Clinical Research Centre, Harrow, U.K.

European Heart Journal
|July 1, 1995
PubMed
Summary
This summary is machine-generated.

Carvedilol improved left ventricular function in patients with heart failure and abnormal wall motion. This beta-blocker shows promise for managing chronic ischemic heart failure by reducing afterload and neurohormonal activation.

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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Carvedilol, a non-selective beta-adrenoceptor antagonist with vasodilating properties, is effective for hypertension and stable angina.
  • Its efficacy in patients with manifest heart failure, particularly those with abnormal left ventricular (LV) function, requires further investigation.

Purpose of the Study:

  • To explore the efficacy of carvedilol in patients with chronic stable angina and abnormal LV wall motion but without overt heart failure.
  • To assess the hemodynamic and clinical responses to carvedilol in patients with chronic ischemic heart failure.

Main Methods:

  • A preliminary single-blind, placebo-controlled study involved six patients with abnormal LV wall motion receiving escalating doses of carvedilol.
  • A subsequent study assessed 17 patients with chronic ischemic heart failure using intravenous and oral carvedilol (50 mg b.i.d.) for 8 weeks.

Main Results:

  • In the preliminary study, carvedilol improved LV wall motion in four of six patients, increasing mean ejection fraction from 40% to 48%.
  • The second study showed improved hemodynamic variables in chronic ischemic heart failure patients, though two withdrew due to postural hypotension and two showed clinical deterioration.
  • Beneficial effects are attributed to reduced afterload and inhibited neurohumeral activation, with findings supported by placebo-controlled, double-blind studies.

Conclusions:

  • Carvedilol demonstrates potential benefits in improving cardiac function and hemodynamics in patients with heart failure and abnormal LV function.
  • The drug's vasodilating and beta-blocking properties may contribute to its efficacy, but careful monitoring for side effects like postural hypotension is necessary.