The Therapeutic Role of ß-Adrenoceptor-Blocking Agents in Severe Heart Failure

Conference paper


Agents with ß-adrenoceptor-blocking properties are of proven therapeutic benefit in patients with symptomatic systolic heart failure of New York Heart Association (NYHA) Class II–III severity. There is now definitive clinical trial data from large-scale studies to support their use in this setting [1–4].


Chronic Heart Failure Severe Heart Failure Data Safety Monitoring Board Adrenergic Blockade Severe Chronic Heart Failure 
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  1. 1.
    Australia/New Zealand Heart Failure Research Collaborative Group. Randomised, placebocontrolled trial of carvedilol in patients with congestive heart failure due to ischaemic heart disease. Lancet 1997; 349: 375–380.CrossRefGoogle Scholar
  2. 2.
    Packer M, Bristow MR, Cohn JN, for the US Carvedilol Heart Failure Study Group. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. New Engl J Med 1996a; 334: 1349–1355.PubMedCrossRefGoogle Scholar
  3. 3.
    CIBIS II Investigators and committees. The Cardiac Insufficiency Bisoprolol Study II (CIBISII): A randomised trial. Lancet 1999; 353: 9–13.CrossRefGoogle Scholar
  4. 4.
    MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure. Lancet 1999; 353: 2001–07.CrossRefGoogle Scholar
  5. 5.
    McMurray JJV, Petne MR, Murdoch DR et al. Clinical epidemiology of heart failure: public and private health burden. Eur Heart J 1998: P 19 (Suppl. P): 9–16.CrossRefGoogle Scholar
  6. 6.
    Cowie MR, Mosterd A, Wood DA et al. The epidemiology of heart failure. Eur Heart J 1997; 18: 208–25.PubMedCrossRefGoogle Scholar
  7. 7.
    Adams KF, Zannad F. Clinical definition and epidemiology of advanced heart failure Am Heart J 1998; 135: S204–S215.PubMedCrossRefGoogle Scholar
  8. 8.
    Ho KLL, Pinsky JL, Kannal WB et al. The epidemiology of heart failure — The Framingham Study. J Am Coll Cardiol 1993: 22: A6–A13.CrossRefGoogle Scholar
  9. 9.
    Deslauriers J and Gregoire J. Surgical therapy of early non-small cell lung cancer. Chest 117, 104S–109S (2000).PubMedCrossRefGoogle Scholar
  10. 10.
    Royal College of General Practitioners, Office of Populations Census and Survery, and Department of Health and Social Security. Morbidity statistics from general practice: fourth national study, 1991-92. London: HMSO. 1995.Google Scholar
  11. 11.
    Stewart AL, Greenfield S, Hays RD et al. Functional status and well-being of patients with chronic conditions-Results from the medical outcomes study. JAMA 1989; 262: 907–13.PubMedCrossRefGoogle Scholar
  12. 12.
    Rundqvist B, Elam M, Bergmann-Sverrisdottir Y et al. Increased cardiac adrenergic drive precedes generalized sympathetic activation in human heart failure. Circulation 1997; 95: 169–175.PubMedCrossRefGoogle Scholar
  13. l3.
    Hasking GJ, Esler MD, Jennings GJ et al. Norepinephrine spillover to plasma in patients with congestive heart failure: evidence of increased overall and cardiorenal sympathetic nervous activity. Circulation 1986; 73: 615–621.PubMedCrossRefGoogle Scholar
  14. 14.
    Colucci WS. Molecular and cellular mechanisms of myocardial failure. Am J Cardiol 1997; 80(suppl): 15L–25L.PubMedCrossRefGoogle Scholar
  15. 15.
    Haft JL. Cardiovascular injury induced by sympathetic catecholamines. Prog Cardiovasc Dis 1974; 17: 73–85.PubMedCrossRefGoogle Scholar
  16. 16.
    Tan LB, Benjamine IT, Clark WA. ß-adrenergic receptor desensitisation may serve a cardioprotective role. Cardiovasc Res 1992; 26: 608–614.PubMedCrossRefGoogle Scholar
  17. 17.
    Narula J, Haider N, Virmani R et al. Apoptosis in myocytes in end-state heart failure. N Engl J Med 1996; 335: 1182–1189.PubMedCrossRefGoogle Scholar
  18. 18.
    Sabbah HN, Goldstein S. Ventricular remodelling: consequences and therapy. Eur Heart J 1993; 14(suppl C): 24–29.PubMedCrossRefGoogle Scholar
  19. 19.
    Cohn JN, Levine TB, Olivari MT et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 1984; 311: 819–823.PubMedCrossRefGoogle Scholar
  20. 20.
    Kaye DM, Lefkovits J, Jennings GL, et al. Adverse consequences of high sympathetic nervous activity in the failing human heart. J am Coll Cardiol 1995; 26: 1257–1263.PubMedCrossRefGoogle Scholar
  21. 21.
    Bristow MR. Mechanisms of action of beta-blocking agents in heart failure. Am J Cardiol 1997; 80 (11 A): 26L–40L.PubMedCrossRefGoogle Scholar
  22. 22.
    Krum H, Sackner-Bernstein JD, Goldsmith RL et al. Double-blind, placebo-controlled study of the long-term efficacy of carvedilol in patients with severe chronic heart failure. Circulation 1995; 92: 1499–1506.PubMedCrossRefGoogle Scholar
  23. 23.
    Cohn JN, Fowler MB, Bristow MR et al. Safety and efficacy of carvedilol in severe heart failure. J Cardiac Failure 1997; 3: 173–179.CrossRefGoogle Scholar
  24. 24.
    MacDonald PS, Keogh AM, Aboyan C et al. Tolerability and efficacy of carvedilol in patients with New York Heart Association Class IV heart failure. J Am Coll Cardiol 1999; 33; 924–931.PubMedCrossRefGoogle Scholar
  25. 25.
    CIBIS Investigators and Committee. A randomized trial of beta-blockade in heart failure: the Cardiac Insufficiency Bisoprolol Study (CIBIS). Circulation 1994; 90: 1765–1773.CrossRefGoogle Scholar
  26. 26.
    Hjalmarson A, Goldstein S, Fagerberg B et al. Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group. JAMA 2000; 283: 1295–302.PubMedCrossRefGoogle Scholar
  27. 27.
    Lechat P, Packer M, Chalon S et al. Clinical effects of beta-adrenergic blockade in chronic heart failure. Circulation 1998; 98: 1184–91.PubMedCrossRefGoogle Scholar
  28. 28.
    Heidenreich PA, Lee TT, Massie BM. Effect of beta-blockade on mortality in patients with heart failure: a meta-analysis of randomized clinical trials. J Am Coll Cardiol 1997; 30: 27–34.PubMedCrossRefGoogle Scholar
  29. 29.
    Doughty RN, Rodgers A, Sharpe N et al. Effects of beta-blocker therapy on mortality in patients with heart failure. Eur Heart J 1997; 18: 560–565.PubMedCrossRefGoogle Scholar
  30. 30.
    The BEST Steering Committee. Design of the beta-blocker evaluation survival trial (BEST). Am J Cardiol 1995; 75: 1220–122.CrossRefGoogle Scholar
  31. 31.
    Whorlow S, Krum H. Meta-analysis of effect of beta-blockade on mortality in NYHA Class IV chronic heart failure patients. Am J Cardiol 2000; 86: 886–889.PubMedCrossRefGoogle Scholar
  32. 32.
    Eichorn EJ. The paradox of ß-adrenergic blockade for the management of congestive heart failure. Am J Med 1992; 92: 527–538.CrossRefGoogle Scholar
  33. 33.
    Willette RN, Mitchell MP, Ohlstein EH et al. Evaluation of intrinsic sympathomimetic activity of bucindolol and carvedilol in rat heart. Pharmacol 1998; 56: 30–36.CrossRefGoogle Scholar
  34. 34.
    The Xamoterol in Severe Heart Failure Study Group. Xamoterol in severe heart failure. Lancet 1990; 336: 1–6.CrossRefGoogle Scholar
  35. 35.
    Hershberger RE, Wynn JR, Sundberg L et al. Mechanism of action of bucindolol in human ventricular myocardium. J Cardiovasc Pharmacol 1990; 15: 959–67.PubMedCrossRefGoogle Scholar
  36. 36.
    Maack C, Cremers B, Flesch M et al. Different intrinsic activity of bucindolol, carvedilol and metoprolol in human failing myocardium. Br J Pharmacol 2000; 130: 1131–39.PubMedCrossRefGoogle Scholar
  37. 37.
    Eichorn E on behalf of the BEST Investigators. Preliminary results of the Beta-Blocker Evaluation Survival trial (BEST). Presented at 72nd Scentific Sessions of the American Heart Association, Atlanta, USA, November 1999.Google Scholar
  38. 38.
    Packer M on behalf of the COPERNICUS Investigators. Preliminary results of the Carvedilol Prospective Randomised Cumulative Survival Trial (COPERNICUS). Presented at the XXIInd Congress of the European Society of Cardiology, August 26-30, Amsterdam, The Netherlands and the 73rd Scientific Session of the American Heart Association, New Orleans, USA, November 12-15, 2000.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • H. Krum

There are no affiliations available

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