Effects of Metoprolol CR in Patients With Ischemic and Dilated Cardiomyopathy

Abstract

The RESOLVD Investigators* Background-Metoprolol provides clinical benefits in patients with congestive heart failure (CHF). In this study, we investigated the effects of controlled-release metoprolol (metoprolol CR) on clinical status, on left ventricular (LV) volumes and function, and on neurohumoral activation in a large number of patients with CHF of mixed causes. Methods and Results-Four hundred twenty-six patients with symptomatic CHF were randomized to receive metoprolol CR or placebo for 24 weeks. Metoprolol CR did not affect 6-minute walk distance, New York Heart Association functional class, or quality of life. However, there was a significant improvement in measures of LV function with an attenuation in the increase in LV end-diastolic (ϩ23Ϯ65 mL [placebo] versus ϩ6Ϯ61 mL, Pϭ0.01) and LV end-systolic (ϩ19Ϯ55 mL [placebo] versus Ϫ2Ϯ51 mL, PϽ0.001) volumes after 24 weeks of therapy. LV ejection fraction was unchanged (Ϫ0.05% or Ϫ0.005) in the placebo group but increased by 2.4% in the metoprolol CR-treated patients (Pϭ0.001). Patients receiving metoprolol CR had a greater decrease in angiotensin II (Pϭ0.036) and renin (Pϭ0.032) levels but an increase in N-terminal atrial natriuretic peptide and brain natriuretic peptide levels (PϽ0.01). There were fewer deaths in the group receiving ␤-blockers (3.4% versus 8.1%), and there was a similar number of patients experiencing the composite outcomes of death or any hospitalization. Conclusions-When added to ACE inhibitors, angiotensin II receptor antagonists, or both, the use of metoprolol CR improves ventricular function, reduces activation of the renin-angiotensin systems, and results in fewer deaths.

Натрийуретические Пептиды И Растворимый ST2-рецептор: Роль В Диагностике, Стратификации Риска И Лечении Больных С Хронической Сердечной Недостаточностью

“…И, наконец, влияние на концентрацию НУП терапии β-адреноблокаторами (β-АБ), которое имеет сложный, как правило, двухфазный характер. В начале лечения β-АБ концентрация BNP может увеличиваться (что не является следствием развития декомпенсации), но в последующем при длительном применении, как правило, происходит снижение концентрации пептидов, что совпадает с улучшением клинического состояния больного с ХСН и отражает эффект терапии на ремоделирование ЛЖ [25][26][27][28].…”