Tolerability of Anti-Adrenergic Treatment of Congestive Heart Failure in Daily Practice

Abstract

A review of the findings of the past decade’s clinical trials with ß blockade provides compelling evidence for the benefits of using these drugs to treat stable chronic heart failure. In the Australia/New Zealand Heart Failure study (ANZ), treatment with carvedilol resulted in a 26% reduction in death or hospitalisation compared with placebo, additional to standard therapy of diuretics, digoxin and an ACE inhibitor [1]. In the US Carvedilol Programme, there was a 65% reduction in the risk of death, and a 53% reduction in heart failure hospitalisations in patients treated with carvedilol, compared with placebo [2]. In the Metoprolol CR/XL Randomised Intervention Trial in Heart Failure (MERIT-HF) study, treatment with metoprolol was associated with a 34% reduction in all-cause mortality compared with placebo [3]; an equivalent finding was also observed in the Cardiac Insufficiency Bisoprolol Study II (CIBIS-II) [4]. A recent meta-analysis of 25 trials totalling 6511 patients, comparing the use of ß-blockade with placebo, additional to standard therapy to treat heart failure patients, demonstrated a 36% reduction in risk of death in patients receiving ß-blockade, compared with those receiving placebo [5].