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Beta blockers in heart failure: a comparison of a vasodilating beta blocker with metoprolol
J E Sanderson1, S K Chan, C M Yu
1Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital. jesanderson@cuhk.edu.hk
Insights
Metoprolol improved chronic heart failure symptoms and function more than celiprolol, a vasodilating beta blocker. Both drugs were well tolerated, but celiprolol offered no long-term clinical advantages in heart failure patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic heart failure (CHF) management remains a clinical challenge.
- Beta blockers are a cornerstone therapy for CHF.
- Third-generation vasodilating beta blockers offer potential therapeutic advantages.
Purpose of the Study:
- To compare the long-term clinical efficacy of celiprolol, a vasodilating beta blocker, against metoprolol in patients with chronic heart failure.
- To assess the clinical advantages of celiprolol's vasodilating properties in heart failure treatment.
Main Methods:
- A double-blind, placebo-controlled, randomized trial was conducted.
- 50 patients with stable chronic heart failure (NYHA class II-IV) were enrolled.
- Patients received celiprolol, metoprolol, or placebo for three months, followed by an open-label period up to one year.
Main Results:
- Metoprolol significantly improved heart failure symptoms, NYHA class, exercise capacity, and left ventricular ejection fraction compared to baseline.
- Celiprolol showed a reduction in symptom score but less improvement in exercise distance and no significant changes in other key parameters.
- One-year mortality was 11% with metoprolol and 19% with celiprolol.
Conclusions:
- Both celiprolol and metoprolol were well-tolerated in patients with chronic heart failure.
- The vasodilating properties of celiprolol did not confer additional long-term clinical benefits over metoprolol.
- Metoprolol demonstrated superior efficacy in improving clinical outcomes for chronic heart failure patients in this study.
Objective:
To determine whether a third generation vasodilating beta blocker (celiprolol) has long term clinical advantages over metoprolol in patients with chronic heart failure.
Design:
A double blind placebo controlled randomised trial.
Setting:
University teaching Hospital.
Patients:
50 patients with stable chronic heart failure (NYHA class II-IV) due to idiopathic dilated, ischaemic, or hypertensive cardiomyopathy, with left ventricular ejection fraction < 0.45.
Interventions:
Celiprolol 200 mg daily (n = 21), metoprolol 50 mg twice daily (n = 19), or placebo (n = 10) for three months with a four week dose titration period. After the double blind period, patients entered an open label study (with placebo group receiving beta blockers) and were assessed after one year.
Main Outcome Measures:
Clinical response, efficacy, and tolerance were assessed by the Minnesota heart failure symptom questionnaire six minute walk test, Doppler echocardiography (systolic and diastolic function), radionuclide ventriculography, and atrial and brain natriuretic peptides measured at baseline and after three months.
Results:
In the metoprolol group at 12 weeks v baseline there was a 47% reduction in symptom score (p < 0.001), improvement of NYHA class (mean (SEM), 2.6 (0.12) to 1.9 (0.13), p = 0.001), exercise distance (1246 (54) to 1402 (52) feet, p < 0.001), and left ventricular ejection fraction (26.9(3.1)% to 31(3.0)%, p = 0.016), and a fall in heart rate (resting, 79 (3) to 62 (3) beats/min, p < 0.001). In the celiprolol group there was a 38% reduction in symptom score (p = 0.02), less improvement in exercise distance (1191 (55) to 1256 (61) feet, p = 0.05), and no significant changes in NYHA class, left ventricular ejection fraction, or heart rate. Mortality at one year was 11% in metoprolol and 19% in the celiprolol group, and symptomatic improvement was maintained in the survivors.
Conclusions:
Both drugs were well tolerated but the vasodilator properties of celiprolol do not seem to provide any obvious additional benefit in the long term treatment of heart failure.