Renato Barroso Pereira de Castro

Replacement of carvedilol for propranolol in patients with heart failure

BACKGROUND Large clinical trials using the betablockers carvedilol, metoprolol, bisoprolol and nebivolol have demonstrated improvement of survival and symptoms in patients with heart failure. Despite the lack of scientific evidence, it is plausible that their beneficial effects are extensible to other betablockers. OBJECTIVE To evaluate the impact of the replacement of carvedilol for propranolol on left ventricular function, functional capacity, quality of life, pressure levels, and cardiac autonomic control in patients with heart failure. METHODS Twenty nine patients receiving optimized drug therapy including maximum tolerated doses of carvedilol were divided into two groups: replacement of carvedilol for propranolol (n = 15) and continued carvedilol (n = 14). At baseline and 6 months later, clinical and laboratorial assessments were carried out with radionuclide ventriculography, echocardiography, Minnesota questionnaire, walk test, APBM and Holter monitoring. RESULTS The clinical and demographic characteristics were similar in the two groups at baseline. Individualized propranolol dose adjustment ensured a similar degree of beta-blockade, as assessed by resting heart rate and chronotropic reserve. The mean propranolol dose used was 109 +/- 43 mg/day. Only one patient presented with intolerance to propranolol, thus carvedilol was reintroduced. One death was recorded in group propranolol. Ejection fraction significantly increased in the propranolol group. No significant change was observed in the other cardiovascular variables after betablocker replacement. CONCLUSION Our results indicate that replacement of carvedilol for propranolol in patients with heart failure is not associated with deterioration of the ejection fraction, functional capacity, quality of life, and other cardiovascular variables related to autonomic and blood pressure control., PP.0-0).FUNDAMENTO: Grandes estudos clinicos empregando os betabloqueadores carvedilol, metoprolol, bisoprolol e nebivolol, demonstraram melhora da sobrevida e dos sintomas em pacientes com insuficiencia cardiaca. Apesar da falta de evidencias cientificas, e plausivel que o efeito benefico seja extensivel a outros betabloqueadores. OBJETIVO: Avaliar em pacientes com insuficiencia cardiaca o impacto da substituicao do carvedilol por propranolol sobre a funcao ventricular esquerda, capacidade funcional, qualidade de vida, niveis pressoricos e controle autonomico cardiaco. METODOS: Vinte e nove pacientes com terapeutica medicamentosa otimizada incluindo doses maximas toleradas de carvedilol foram divididos em dois grupos: substituicao de carvedilol por propranolol (n = 15) e manutencao de carvedilol (n = 14). Na condicao basal, e apos 6 meses, foram realizadas avaliacoes clinica e laboratorial com: ventriculografia nuclear, ecocardiografia, questionario de Minnesota, teste de caminhada, MAPA e Holter. RESULTADOS: As caracteristicas laboratoriais e demograficas foram similares nos dois grupos na avaliacao inicial. Ajuste individualizado da dose do propranolol garantiu grau semelhante de betabloqueio avaliado pela frequencia cardiaca em repouso e reserva cronotropica. A dose media de propranolol usada foi 109 ± 43 mg/dia. Apenas um paciente apresentou intolerância ao propranolol com retorno do carvedilol. Foi registrado um obito no grupo propranolol. A fracao de ejecao apresentou aumento significativo no grupo propranolol. As demais variaveis cardiovasculares nao sofreram modificacoes significativas apos troca do betabloqueador. CONCLUSAO: Nossos resultados indicam que a substituicao do carvedilol por propranolol em pacientes com insuficiencia cardiaca nao esta associada a deterioracao da fracao de ejecao, da capacidade funcional, da qualidade de vida e das variaveis cardiovasculares de controle pressorico e autonomico.

Substituição do carvedilol pelo propranolol em pacientes com insuficiência cardíaca

BACKGROUND Large clinical trials using the betablockers carvedilol, metoprolol, bisoprolol and nebivolol have demonstrated improvement of survival and symptoms in patients with heart failure. Despite the lack of scientific evidence, it is plausible that their beneficial effects are extensible to other betablockers. OBJECTIVE To evaluate the impact of the replacement of carvedilol for propranolol on left ventricular function, functional capacity, quality of life, pressure levels, and cardiac autonomic control in patients with heart failure. METHODS Twenty nine patients receiving optimized drug therapy including maximum tolerated doses of carvedilol were divided into two groups: replacement of carvedilol for propranolol (n = 15) and continued carvedilol (n = 14). At baseline and 6 months later, clinical and laboratorial assessments were carried out with radionuclide ventriculography, echocardiography, Minnesota questionnaire, walk test, APBM and Holter monitoring. RESULTS The clinical and demographic characteristics were similar in the two groups at baseline. Individualized propranolol dose adjustment ensured a similar degree of beta-blockade, as assessed by resting heart rate and chronotropic reserve. The mean propranolol dose used was 109 +/- 43 mg/day. Only one patient presented with intolerance to propranolol, thus carvedilol was reintroduced. One death was recorded in group propranolol. Ejection fraction significantly increased in the propranolol group. No significant change was observed in the other cardiovascular variables after betablocker replacement. CONCLUSION Our results indicate that replacement of carvedilol for propranolol in patients with heart failure is not associated with deterioration of the ejection fraction, functional capacity, quality of life, and other cardiovascular variables related to autonomic and blood pressure control., PP.0-0).FUNDAMENTO: Grandes estudos clinicos empregando os betabloqueadores carvedilol, metoprolol, bisoprolol e nebivolol, demonstraram melhora da sobrevida e dos sintomas em pacientes com insuficiencia cardiaca. Apesar da falta de evidencias cientificas, e plausivel que o efeito benefico seja extensivel a outros betabloqueadores. OBJETIVO: Avaliar em pacientes com insuficiencia cardiaca o impacto da substituicao do carvedilol por propranolol sobre a funcao ventricular esquerda, capacidade funcional, qualidade de vida, niveis pressoricos e controle autonomico cardiaco. METODOS: Vinte e nove pacientes com terapeutica medicamentosa otimizada incluindo doses maximas toleradas de carvedilol foram divididos em dois grupos: substituicao de carvedilol por propranolol (n = 15) e manutencao de carvedilol (n = 14). Na condicao basal, e apos 6 meses, foram realizadas avaliacoes clinica e laboratorial com: ventriculografia nuclear, ecocardiografia, questionario de Minnesota, teste de caminhada, MAPA e Holter. RESULTADOS: As caracteristicas laboratoriais e demograficas foram similares nos dois grupos na avaliacao inicial. Ajuste individualizado da dose do propranolol garantiu grau semelhante de betabloqueio avaliado pela frequencia cardiaca em repouso e reserva cronotropica. A dose media de propranolol usada foi 109 ± 43 mg/dia. Apenas um paciente apresentou intolerância ao propranolol com retorno do carvedilol. Foi registrado um obito no grupo propranolol. A fracao de ejecao apresentou aumento significativo no grupo propranolol. As demais variaveis cardiovasculares nao sofreram modificacoes significativas apos troca do betabloqueador. CONCLUSAO: Nossos resultados indicam que a substituicao do carvedilol por propranolol em pacientes com insuficiencia cardiaca nao esta associada a deterioracao da fracao de ejecao, da capacidade funcional, da qualidade de vida e das variaveis cardiovasculares de controle pressorico e autonomico.

Sustitución del carvedilol por el propranolol en pacientes con insuficiencia cardíaca

BACKGROUND Large clinical trials using the betablockers carvedilol, metoprolol, bisoprolol and nebivolol have demonstrated improvement of survival and symptoms in patients with heart failure. Despite the lack of scientific evidence, it is plausible that their beneficial effects are extensible to other betablockers. OBJECTIVE To evaluate the impact of the replacement of carvedilol for propranolol on left ventricular function, functional capacity, quality of life, pressure levels, and cardiac autonomic control in patients with heart failure. METHODS Twenty nine patients receiving optimized drug therapy including maximum tolerated doses of carvedilol were divided into two groups: replacement of carvedilol for propranolol (n = 15) and continued carvedilol (n = 14). At baseline and 6 months later, clinical and laboratorial assessments were carried out with radionuclide ventriculography, echocardiography, Minnesota questionnaire, walk test, APBM and Holter monitoring. RESULTS The clinical and demographic characteristics were similar in the two groups at baseline. Individualized propranolol dose adjustment ensured a similar degree of beta-blockade, as assessed by resting heart rate and chronotropic reserve. The mean propranolol dose used was 109 +/- 43 mg/day. Only one patient presented with intolerance to propranolol, thus carvedilol was reintroduced. One death was recorded in group propranolol. Ejection fraction significantly increased in the propranolol group. No significant change was observed in the other cardiovascular variables after betablocker replacement. CONCLUSION Our results indicate that replacement of carvedilol for propranolol in patients with heart failure is not associated with deterioration of the ejection fraction, functional capacity, quality of life, and other cardiovascular variables related to autonomic and blood pressure control., PP.0-0).FUNDAMENTO: Grandes estudos clinicos empregando os betabloqueadores carvedilol, metoprolol, bisoprolol e nebivolol, demonstraram melhora da sobrevida e dos sintomas em pacientes com insuficiencia cardiaca. Apesar da falta de evidencias cientificas, e plausivel que o efeito benefico seja extensivel a outros betabloqueadores. OBJETIVO: Avaliar em pacientes com insuficiencia cardiaca o impacto da substituicao do carvedilol por propranolol sobre a funcao ventricular esquerda, capacidade funcional, qualidade de vida, niveis pressoricos e controle autonomico cardiaco. METODOS: Vinte e nove pacientes com terapeutica medicamentosa otimizada incluindo doses maximas toleradas de carvedilol foram divididos em dois grupos: substituicao de carvedilol por propranolol (n = 15) e manutencao de carvedilol (n = 14). Na condicao basal, e apos 6 meses, foram realizadas avaliacoes clinica e laboratorial com: ventriculografia nuclear, ecocardiografia, questionario de Minnesota, teste de caminhada, MAPA e Holter. RESULTADOS: As caracteristicas laboratoriais e demograficas foram similares nos dois grupos na avaliacao inicial. Ajuste individualizado da dose do propranolol garantiu grau semelhante de betabloqueio avaliado pela frequencia cardiaca em repouso e reserva cronotropica. A dose media de propranolol usada foi 109 ± 43 mg/dia. Apenas um paciente apresentou intolerância ao propranolol com retorno do carvedilol. Foi registrado um obito no grupo propranolol. A fracao de ejecao apresentou aumento significativo no grupo propranolol. As demais variaveis cardiovasculares nao sofreram modificacoes significativas apos troca do betabloqueador. CONCLUSAO: Nossos resultados indicam que a substituicao do carvedilol por propranolol em pacientes com insuficiencia cardiaca nao esta associada a deterioracao da fracao de ejecao, da capacidade funcional, da qualidade de vida e das variaveis cardiovasculares de controle pressorico e autonomico.