Comparative Effects of Carvedilol vs Bisoprolol for Severe Congestive Heart Failure - Special Reference to Atrial Fibrillation -

Konishi, Masanori; Haraguchi, Go; Kimura, Shigeki; Inagaki, Hiroshi; Kawabata, Mihoko; Hirao, Kazuyuki; Isobe, Mitsuaki

doi:10.1253/circj.cj-09-0989

Cited by 39 publications

(33 citation statements)

References 31 publications

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“…This finding is consistent with a study by Konishi et al, who noted a significant decrease in HR among 110 Japanese patients assigned to a low-dose carvedilol regimen for 18 months. 45 Moreover, in a meta-analysis of HF β-blocker trials, McAlister et al observed a relationship between the extent of the reduction in HR, not the dose of β-blocker, and the magnitude of increased survival. 43 HR reduction is regarded as a marker of sympathetic suppression.…”

Section: Discussionmentioning

confidence: 99%

Safety and Tolerability of Once-Daily Controlled-Release Carvedilol 10-80mg in Japanese Patients With Chronic Heart Failure

Kitakaze

Sarai

Ando

et al. 2012

Circ J

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Section: Discussionmentioning

confidence: 99%

Safety and Tolerability of Once-Daily Controlled-Release Carvedilol 10-80mg in Japanese Patients With Chronic Heart Failure

Kitakaze

Sarai

Ando

et al. 2012

Circ J

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“…4,5) Among the 3 BBs that have been shown to be effective in systolic HF, ie, carvedilol, bisoprolol, and metoprolol succinate, carvedilol has been used the most all over the world. [6][7][8] The approved maximal dose is 20 mg/day in Japan, whereas its standard dose in the United States and Europe is 50 mg/day. HF guidelines from the US 4) and Europe 5) state that BBs should be titrated as much as tolerated.…”

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confidence: 99%

High Dose <i>β</i>-Blocker Therapy Triggers Additional Reverse Remodeling in Patients With Idiopathic Non-Ischemic Cardiomyopathy

et al. 2016

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SummaryCarvedilol has established its evidence to improve prognosis and facilitate left ventricular reverse remodeling (LVRR) in heart failure patients with reduced left ventricular ejection fraction (LVEF), and many studies have supported its dose-dependency. However, there are few studies demonstrating the effect of high dose carvedilol in Japan. We enrolled 23 patients with idiopathic non-ischemic cardiomyopathy, in whom LVEF remained 45% or less despite 20 mg/ day of carvedilol therapy for > 3 months. After high dose (40 mg/day) carvedilol therapy for > 3 months, LVEF improved (+9.1%, P = 0.002), and LV end-diastolic diameter (LVDd) and LV end-systolic diameter (LVDs) reduced (-4.6 and -6.9 mm, respectively, P < 0.05) compared with the baseline data. Finally, 17 patients achieved LVRR after the high dose, when LVRR was defined as 1) those with final EF > 45%, and 2) those with final EF < 45% but who attained increases in LVEF > 10%, or LVEF > 5% with a decrease in LV end-diastolic dimension index (LVDDI) > 5%. Baseline predictors for LVRR after high dose carvedilol were the change rates of log B-type natriuretic peptide (BNP), LVDd, and LVDs from the time of pre-carvedilol introduction to enrollment (P < 0.05, respectively). In conclusion, high dose carvedilol triggered additional LVRR in patients with idiopathic non-ischemic cardiomyopathy and the change rates of log BNP, LVDd, and LVDs at 20 mg carvedilol may be predictors for the additional LVRR at high dose. (Int Heart J 2016; 57: 717-724) Key words: Carvedilol, Heart failure, Ejection fraction β -Blockers (BBs) have established the evidence to improve the prognosis of chronic heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF), [1][2][3] and are recommended as one of the first line drugs in all HF guidelines. 4,5) Among the 3 BBs that have been shown to be effective in systolic HF, ie, carvedilol, bisoprolol, and metoprolol succinate, carvedilol has been used the most all over the world. [6][7][8] The approved maximal dose is 20 mg/day in Japan, whereas its standard dose in the United States and Europe is 50 mg/day. HF guidelines from the US 4) and Europe 5) state that BBs should be titrated as much as tolerated. However, a post-marketing surveillance study in Japanese HF patients reported that carvedilol was then prescribed at approximately 7.2 mg/day on average. 9) Similarly, the mean dosage of carvedilol was 25 mg/day, ie, half of the target dose in Europe in the SHIFT study.10) As such, BBs are underused in terms of their dosage in real-world clinical practice.When a new drug is introduced into Japan, approximately the half dose of that in Western countries has often been adopted as the maximal dose for Japanese simply because of their smaller average build. In most Japanese clinical trials, the protocols set the target dose of any medications relatively low. This was also the case for carvedilol. However, probably because of the Westernization of Japanese dietary habits, the improvement in the average build is q...

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“…The polymorphism has gained much attention because, when overexpressed at very high levels KEYWORDS: b-blockers n ADBR1 gene polymorphisms n atrial fibrillation n bisoprolol n carvedilol n heart failure in heterologous cell systems, the Gly389 variant stimulates cAMP synthesis fivefold less than the Arg389 variant, that is, it is a minus variant. Since chronic hyperactivity of b1-adrenoceptors is thought to adversely affect cardiovascular outcome and b-blockade improves it [7,8], it was initially assumed that the homozygous presence of the Arg389 variant would confer a higher risk in patients at high cardiac risk, on the one hand, and better response to b-blockade on the other hand. Indeed, in retrospective clinical analyses, some studies in transgenic mice and isolated human heart muscle preparations reported higher signaling activity of the Arg389 variant and greater responses to b-blockade (see overview in [9,10]).…”

mentioning

confidence: 99%

A frequent Gene Polymorphism Affecting the Heart-rate Response to Carvedilol

Eschenhagen

2013

Pharmacogenomics

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Comparative Effects of Carvedilol vs Bisoprolol for Severe Congestive Heart Failure - Special Reference to Atrial Fibrillation -

Cited by 39 publications

References 31 publications

Safety and Tolerability of Once-Daily Controlled-Release Carvedilol 10-80mg in Japanese Patients With Chronic Heart Failure

Safety and Tolerability of Once-Daily Controlled-Release Carvedilol 10-80mg in Japanese Patients With Chronic Heart Failure

High Dose <i>β</i>-Blocker Therapy Triggers Additional Reverse Remodeling in Patients With Idiopathic Non-Ischemic Cardiomyopathy

A frequent Gene Polymorphism Affecting the Heart-rate Response to Carvedilol

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