Beta blockade in congestive heart failure: persistent adverse haemodynamic effects during chronic treatment with subsequent doses.
OBJECTIVE
To determine whether the acute adverse haemodynamic effects of beta blockade in patients with congestive heart failure persist during chronic treatment.


METHODS
Sequential haemodynamic evaluation of heart failure patients at baseline and after three months of continuous treatment with the beta 1 selective antagonist metoprolol.


METHODS
Cardiac care unit in university hospital.


METHODS
26 patients with moderate to severe congestive heart failure (New York Heart Association grade II to IV) and background treatment with digoxin, diuretics, and angiotensin converting enzyme inhibitors, and with a left ventricular ejection fraction < 25%.


METHODS
Baseline variables included a six minute walk, maximum oxygen consumption, and right heart catheterisation. All patients received metoprolol 6.25 mg orally twice daily initially and the dose was gradually increased to a target of 50 mg twice daily. Haemodynamic measurements were repeated after three months of treatment, both before (trough) and after drug readministration.


RESULTS
Long term metoprolol had functional, exercise, and haemodynamic benefits. It produced decreases in heart rate, pulmonary capillary wedge pressure, and systemic vascular resistance, and increases in cardiac index, stroke volume index, and stroke work index. However, when full dose metoprolol was readministered during chronic treatment, there was a reduction in cardiac index (from 2.8 (SD 0.46) to 2.3 (0.38) l/min/m2, p << 0.001) and stroke work index (from 31.4 (11.1) to 26.6 (10.0) g.m/m2, p < 0.001) and an increase in systemic vascular resistance (from 943 (192) to 1160 (219) dyn.s.cm-5, p << 0.001).


CONCLUSIONS
Adverse haemodynamic effects of beta blockers in heart failure persist during chronic treatment, as shown by worsening haemodynamic indices with subsequent doses.
Kukin
M L
ML
Heart Failure Program, Mount Sinai Medical Center, New York, New York 10029, USA. marrick_kukin@SMTPlink.mssm.edu
Kalman
J
J
Mannino
M M
MM
Buchholz-Varley
C
C
Ocampo
O
O
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D014655:Vascular Resistance / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D008790:Metoprolol