Erschienen in:
01.08.2010
Which Beta-Blocker is Most Effective in Heart Failure?
verfasst von:
Willem J. Remme
Erschienen in:
Cardiovascular Drugs and Therapy
|
Ausgabe 4/2010
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Excerpt
Since the mid-late nineties beta-blockade has become one of the pillars of chronic heart failure treatment. Based on a significant and consistent beneficial effect on survival and a reduction of worsening heart failure (HF) in large, placebo-controlled studies performed at that time, beta-blockade has been accepted as mandatory therapy in patients with stable mild, moderate and severe HF. These pivotal studies were, in order of sequence: the US carvedilol programme (carvedilol), CIBIS II (bisoprolol), MERIT-HF (metoprolol), and COPERNICUS (carvedilol) performed in patients with chronic HF and left ventricular (LV) dysfunction [
1‐
4]. Whereas the focus in the first 3 studies was in mild/moderate HF, COPERNICUS was exclusively carried out in patients with severe, albeit stable. HF. In addition, in patients with LV dysfunction and/or HF directly after an acute myocardial infarction, carvedilol also significantly improved survival compared to placebo treatment [
5]. A later study, SENIORS, performed in an elderly population irrespective of cardiac function with nebivolol, showed a significant reduction in the primary outcome, a composite of all-cause mortality and hospital admission for HF, but for all-cause mortality alone [
6]. In all of these studies background therapy included ACE inhibitors. …
