[Beta-blockers and heart failure--a critical view].
Recently, several randomised controlled studies have demonstrated improvement in survival of patients with non ischemic cardiomyopathy (Bisoprolol, Metoprolol, Carvedilol) and ischemic cardiomyopathy (Carvedilol). It is not quite clear, whether the observed difference in mortality after beta-blockade on top of diuretics, digitalis and ACE-inhibitors is due to some as yet unknown pathophysiological changes. Certainly, beta-blocking agents have an established efficacy in arrhythmia. Irrespective of the acknowledged benefit in survival, one should note, that the risk reduction in mortality by 65% by Carvedilol has to be viewed critically-as the risk reductions in several other large scale trials. If the mortality in the group receiving digitalis, diuretics and ACE-inhibitors was 7.8%, the mortality after addition of Carvedilol was 3.2%. This means a difference of 4.6%. If however, percent from percent is calculated, than the risk reduction amounts to 65%. One can easily understand, why this larger latter, number usually is being published.
Erdmann
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Klinik III für Innere Medizin, der Universität zu Köln.
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D002227:Carbazoles / Q000009:adverse effects / Q000627:therapeutic use; D000077261:Carvedilol; D004071:Digitalis Glycosides / Q000009:adverse effects / Q000627:therapeutic use; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D011412:Propanolamines / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002227:Carbazoles; D004071:Digitalis Glycosides; D004232:Diuretics; D011412:Propanolamines; D000077261:Carvedilol
Beta-blocker und Herzinsuffizienz--Eine kritische Betrachtung.