Differences Between Beta-Blockers in Patients With Chronic Heart Failure and Chronic Obstructive Pulmonary Disease
| Autor: | Andrew Jabbour, Maros Elsik, Eugene Kotlyar, Peter S. Macdonald, Christopher S. Hayward, Henry Krum, Søren Mellemkjær, Cathie F. Coleman, Anne Keogh |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
Ejection fraction medicine.drug_class business.industry medicine.disease Brain natriuretic peptide Bisoprolol Heart failure Internal medicine Anesthesia medicine Cardiology Respiratory function business Cardiology and Cardiovascular Medicine Carvedilol Beta blocker medicine.drug Metoprolol |
| Zdroj: | Journal of the American College of Cardiology. 55(17):1780-1787 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2010.01.024 |
| Popis: | Objectives The purpose of this study was to determine the respiratory, hemodynamic, and clinical effects of switching between β1-selective and nonselective beta-blockers in patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Background Carvedilol, metoprolol succinate, and bisoprolol are established beta-blockers for treating CHF. Whether differences in beta-receptor specificities affect lung or vascular function in CHF patients, particularly those with coexistent COPD, remains incompletely characterized. Methods A randomized, open label, triple-crossover trial involving 51 subjects receiving optimal therapy for CHF was conducted in 2 Australian teaching hospitals. Subjects received each beta-blocker, dose-matched, for 6 weeks before resuming their original beta-blocker. Echocardiography, N-terminal pro-hormone brain natriuretic peptide, central augmented pressure from pulse waveform analysis, respiratory function testing, 6-min walk distance, and New York Heart Association (NYHA) functional class were assessed at each visit. Results Of 51 subjects with a mean age of 66 ± 12 years, NYHA functional class I (n = 6), II (n = 29), or III (n = 16), and left ventricular ejection fraction mean of 37 ± 10%, 35 had coexistent COPD. N-terminal pro-hormone brain natriuretic peptide was significantly lower with carvedilol than with metoprolol or bisoprolol (mean: carvedilol 1,001 [95% confidence interval (CI): 633 to 1,367] ng/l; metoprolol 1,371 [95% CI: 778 to 1,964] ng/l; bisoprolol 1,349 [95% CI: 782 to 1,916] ng/l; p Conclusions Switching between β1-selective beta-blockers and the nonselective beta-blocker carvedilol is well tolerated but results in demonstrable changes in airway function, most marked in patients with COPD. Switching from β1-selective beta-blockers to carvedilol causes short-term reduction of central augmented pressure and N-terminal pro-hormone brain natriuretic peptide. (Comparison of Nonselective and Beta1-Selective Beta-Blockers on Respiratory and Arterial Function and Cardiac Chamber Dynamics in Patients With Chronic Stable Congestive Cardiac Failure; Australian New Zealand Clinical Trials Registry, ACTRN12605000504617) |
| Databáze: | OpenAIRE |
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