|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2004; 44:1825-1830, doi:10.1016/j.jacc.2004.05.087 © 2004 by the American College of Cardiology Foundation |
* Department of Cardiology, Chris-Hani-Baragwanath Hospital, Johannesburg, South Africa
Department of Chemical Pathology, Chris-Hani-Baragwanath Hospital, Johannesburg, South Africa
Department of Physiology, University of the Witwatersrand, Johannesburg, South Africa
Manuscript received March 7, 2004; revised manuscript received May 13, 2004, accepted May 18, 2004.
* Reprint requests and correspondence: Prof. Karen Sliwa, Department of Cardiology, Chris-Hani Baragwanath Hospital, P.O. Bertsham 2013, Johannesburg, South Africa (Email: hahnle{at}netactive.co.za).
OBJECTIVES: The purpose of this research was to evaluate the therapeutic value of initiating a beta-blocker before an angiotensin-converting enzyme inhibitor (ACEI) in the treatment of heart failure.
BACKGROUND: Although ACEI and carvedilol produce benefits in heart failure, whether the order of initiation of therapy determines the impact on left ventricular (LV) function and New York Heart Association functional class (NYHA FC) has not been determined.
METHODS: A single-center, prospective, randomized, open-label study was performed. We evaluated whether initiation of therapy with carvedilol either before (n = 38) or after (n = 40) perindopril therapy in newly diagnosed patients in NYHA FC II to III heart failure with idiopathic dilated cardiomyopathy, with the addition of the alternative agent after six months, determined subsequent changes in NYHA FC and LV function (echocardiography and radionuclide ventriculography). Study drugs were titrated to maximum tolerable doses.
RESULTS: There were no differences in baseline characteristics between the study groups. After 12 months 11 patients died (6 in the group where the ACEI was initiated). At 12 months the group receiving carvedilol as initial therapy achieved a higher tolerable dose of carvedilol (43 ± 17 mg vs. 33 ± 18 mg, p = 0.03); a lower dose of furosemide (p < 0.05); and better improvements in symptoms (NYHA FC, p < 0.002), LV ejection fraction (radionuclide: 15 ± 16% vs. 6 ± 13%, p < 0.05; echocardiographic, p < 0.01), and plasma N-terminal pro-brain natriuretic peptide concentrations (p < 0.02).
CONCLUSIONS: As opposed to the conventional sequence of drug use in the treatment of heart failure, initiation of therapy with carvedilol before an ACEI results in higher tolerable doses of carvedilol and better improvements in FC and LV function.
| ||||||||||
Related Article
J. Am. Coll. Cardiol. 2004 44: 1831-1833.
This article has been cited by other articles:
|
|
 |
|
  A. Damasceno, G. Cotter, A. Dzudie, K. Sliwa, and B. M. Mayosi Heart Failure in Sub-Saharan Africa: Time for Action J. Am. Coll. Cardiol., October 23, 2007; 50(17): 1688 - 1693. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Willenheimer and P. Lechat New concepts in managing patients with chronic heart failure: the evolving importance of beta-blockade Eur. Heart J. Suppl., June 1, 2006; 8(suppl_C): C3 - C4. [Full Text] [PDF]
|
|
|
|
|
|
P. Ponikowski Rationale and design of CIBIS III Eur. Heart J. Suppl., June 1, 2006; 8(suppl_C): C35 - C42. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.H. W. Tang and G. S. Francis The Year in Heart Failure J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2125 - 2133. [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Fang Angiotensin-Converting Enzyme Inhibitors or {beta}-Blockers in Heart Failure: Does It Matter Who Goes First? Circulation, October 18, 2005; 112(16): 2380 - 2382. [Full Text] [PDF]
|
|
|
|
|
|
R. Willenheimer, D. J. van Veldhuisen, B. Silke, E. Erdmann, F. Follath, H. Krum, P. Ponikowski, A. Skene, L. van de Ven, P. Verkenne, et al. Effect on Survival and Hospitalization of Initiating Treatment for Chronic Heart Failure With Bisoprolol Followed by Enalapril, as Compared With the Opposite Sequence: Results of the Randomized Cardiac Insufficiency Bisoprolol Study (CIBIS) III Circulation, October 18, 2005; 112(16): 2426 - 2435. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Krum, S. J. Haas, E. Eichhorn, J. Ghali, E. Gilbert, P. Lechat, M. Packer, E. Roecker, P. Verkenne, H. Wedel, et al. Prognostic benefit of beta-blockers in patients not receiving ACE-Inhibitors Eur. Heart J., October 2, 2005; 26(20): 2154 - 2158. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Willenheimer Implications of CIBIS III: A Commentary Journal of Renin-Angiotensin-Aldosterone System, September 1, 2005; 6(3): 115 - 120. [Abstract] [PDF]
|
|
|
|
|
|
R. Willenheimer, D. J. van Veldhuisen, P. Ponikowski, P. Lechat, and on behalf of the CIBIS-II Steering Committee and I Beta-Blocker Treatment Before Angiotensin-Converting Enzyme Inhibitor Therapy in Newly Diagnosed Heart Failure J. Am. Coll. Cardiol., July 5, 2005; 46(1): 182 - 182. [Full Text] [PDF]
|
|
|
|
|
|
K. Sliwa and M. R. Essop Reply J. Am. Coll. Cardiol., July 5, 2005; 46(1): 183 - 183. [Full Text] [PDF]
|
|
|
|
|
|
Y. Law Impact of Carvedilol Before Angiotensin-Converting Enzyme Inhibitor Therapy on Cardiac Function J. Am. Coll. Cardiol., July 5, 2005; 46(1): 181 - 182. [Full Text] [PDF]
|
|
|
|
|
|
R. J. MacFadyen and R. Davis Treatment Order in Managing Systolic Ventricular Dysfunction J. Am. Coll. Cardiol., July 5, 2005; 46(1): 182 - 183. [Full Text] [PDF]
|
|
|
|
|
|
A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, B. H. Greenberg, J. D. Knoke, K. U. Knowlton, W. Y.W. Lew, J. Narula, D. Sahn, et al. Highlights of the year in JACC 2004 J. Am. Coll. Cardiol., January 4, 2005; 45(1): 137 - 153. [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
