摘要
The purpose of this research was to evaluate the therapeutic value of initiati ng a beta-blocker before an angiotensin-converting enzyme inhibitor(ACEI) in t he treatment of heart failure. AlthoughACEI and carvedilol produce benefits in h eart failure, whether the order of initiation of therapy determines the impact o n left ventricular (LV) function and New York Heart Association functional class (NYHA FC) has not been determined. A single-center, prospective, randomized, op en-label study was performed. We eval uated 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 hear t failure with idiopathic dilated cardiomyopathy, with the addition of the alter native agent after six months, determined subsequent changes in NYHA FC and LV f unction(echocardiography and radionuclide ventriculography). Study drugs were ti trated to maximum tolerable doses. There were no differences in baseline charact eristics between the study groups. After 12months 11 patients died (6 in the gro upwhere theACEI was initiated). At 12 months the group receiving carvedilol as i nitial 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). As opposed to the conventional se quence 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 b etter improvements in FC and LV function.
The purpose of this research was to evaluate the therapeutic value of initiati ng a beta-blocker before an angiotensin-converting enzyme inhibitor(ACEI) in t he treatment of heart failure. AlthoughACEI and carvedilol produce benefits in h eart failure, whether the order of initiation of therapy determines the impact o n left ventricular (LV) function and New York Heart Association functional class (NYHA FC) has not been determined. A single-center, prospective, randomized, op en-label study was performed. We eval uated 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 hear t failure with idiopathic dilated cardiomyopathy, with the addition of the alter native agent after six months, determined subsequent changes in NYHA FC and LV f unction(echocardiography and radionuclide ventriculography). Study drugs were ti trated to maximum tolerable doses. There were no differences in baseline charact eristics between the study groups. After 12months 11 patients died (6 in the gro upwhere theACEI was initiated). At 12 months the group receiving carvedilol as i nitial 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). As opposed to the conventional se quence 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 b etter improvements in FC and LV function.
