![]() BETA BLOCKERS OK TO TAKE AS NEEDED TRIAL13 Meanwhile, the Carvedilol Post Infarction Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial showed that carvedilol improved outcomes in patients with LV dysfunction (LV ejection fraction 100 mm Hg, carvedilol was started at 12.5 mg b.i.d. The Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial showed that the benefits of carvedilol with respect to mortality as well as morbidity could be extended to patients with severe HF, those with symptoms at rest or on minimal exertion, and with an ejection fraction (EF) less than 25%. 11, 12 Two recent studies of carvedilol extend this recommendation to different classes of patients. 9, 10īased on this convincing evidence, both the Consensus Recommendations for the Management of Chronic Heart Failure and the Heart Failure Society of America Practice Guidelines mandate that all patients with New York Heart Association (NYHA) functional class II or III HF should be treated with a β blocker unless there is a contraindication to its use in a particular patient, or if the patient has been shown to be unable to tolerate treatment with the drug. 7, 8 Indeed, the majority of β-blocker mortality trials have consistently shown a favorable effect on mortality, with a relative decrease at least as great as that produced with ACE inhibitors alone. 1- 6 In fact, approximately 6000 patients evaluated in more than 20 trials have shown a variety of benefits including reduction in death, hospitalizations, and progression of HF, as well as improved left ventricular (LV) function when β blockers are combined with angiotensin-converting enzyme (ACE) inhibitors and diuretics. Over the past decade, numerous large-scale randomized controlled trials (RCTs) have demonstrated the significant mortality and morbidity benefits of β-blocker therapy in the management of mild or moderate heart failure (HF). The optimal selection and use of adrenergic-blocking agents in the cardiovascular continuum will assist in providing improved management while minimizing safety and tolerability concerns.īeta blockers are widely utilized for both cardiovascular and noncardiovascular indications, such as hypertension, angina, and the treatment of migraine headache. Two protocols for switching between carvedilol, a third-generation nonselective agent with vasodilation through α 1 blockade, and a β 1-selective agent (e.g., metoprolol, atenolol) are described to simplify the process and maximize the safety and tolerability of this procedure. For example, the similarities and differences of receptor subtype blockade of the two agents and the potential effects of ancillary properties. Because of the differences among β blockers, switching should be conducted in a manner that takes into account pharmacologic differences. BETA BLOCKERS OK TO TAKE AS NEEDED HOW TOAs cardiovascular disease progresses, the issue of switching from one β blocker to another is an important consideration as to how to optimize the effectiveness of adrenergic blockade. In fact, β blockers are a heterogeneous group of agents with respect to pharmacology, receptor biology, hemodynamic effects, and tolerability. This is especially true in HF, where differences in reverse remodeling and effects on the periphery may be important differentiating factors leading to improved efficacy. However, β blockers do not all share the same clinical outcomes with respect to efficacy or safety in many of these conditions. The clinical benefit of β blockade has been proven in a variety of pathologic settings, including hypertension, angina pectoris, acute- and post-myocardial infarction, and congestive heart failure. ![]()
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