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THE BETA-BLOCKER CARVEDILOL FOR CHF.

Evidence is mounting that beta blockade benefits some patients with congestive heart failure (CHF) by attenuating the adverse effects of chronic activation of the sympathetic nervous system. This randomized multicenter trial examined outcomes with carvedilol, a nonselective beta-blocker with alpha-blocking and antioxidant properties, in patients with CHF (mean ejection fraction, 23 percent).

Nearly all patients were already on digoxin, diuretics, and ACE inhibitors. The trial's numerous exclusion criteria included the following: having a recent major cardiovascular event, hypertension or hypotension, bradycardia, and renal or hepatic disease. During an initial two-week phase in which all subjects received low-dose carvedilol to assess tolerance to the drug, 2 percent had worsening CHF or died, leaving 1094 patients randomized to carvedilol or placebo.

During a median follow-up of 6.5 months, the mortality rate was significantly lower with carvedilol than with placebo (3.2 vs. 7.8 percent), mainly owing to reductions in progressive CHF and sudden death. The risk of death or cardiac hospitalization was also lower with carvedilol (15.8 vs. 24.6 percent).

Comment: An editorial warns that we should not take lightly the potential for early decompensation of CHF with beta-blockers, as seen during the first phase of this study. Nevertheless, judicious use of beta blockers is a potentially important therapeutic advance in CHF treatment. Additional trials with other agents are in progress.

— AS Brett

Published in Journal Watch General Medicine June 11, 1996

Citation(s):

Packer M et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996 May 23 334 1349-1355.

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Pfeffer MA; Stevenson LW. Beta-adrenergic blockers and survival in heart failure. N Engl J Med 1996 May 23 334 1396-1397.

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• Medline abstract (Free)