Significance of combined angiotensin II receptor blocker and carvedilol therapy in patients with congestive heart failure and arginine variant.
OBJECTIVE
Angiotensin II receptor blockers (ARBs) and beta-blockers have contributed to longer life expectancies for patients with congestive heart failure. However, whether the use of ARBs is helpful for introducing carvedilol (beta-blocker) is unclear when patients with symptomatic congestive heart failure are admitted to the hospital.


METHODS
In this retrospective study, 27 patients with symptomatic congestive heart failure were given carvedilol upon admission. Five patients received carvedilol monotherapy (group A), and 22 were treated with a combination of carvedilol and ARBs (group B).


RESULTS
There was no difference in medication between the groups except for ARBs. In addition, there were no significant differences in the decrease in plasma brain natriuretic peptide, or the improvement of left ventricular ejection fraction upon carvedilol treatment between the groups. Although there was no significant difference in the maintenance dose of carvedilol between the groups, the gross dose of carvedilol in group B was significantly lower than that in group A. In addition, the improvement of left ventricular ejection fraction in group B was positively correlated with the maintenance dose of carvedilol in patients who had wild-type beta1-adrenergic receptor at amino acid 389 (arginine/arginine genotype).


CONCLUSIONS
These results suggest that ARBs are helpful for introducing carvedilol in patients with the wild-type beta1-adrenergic receptor gene, and that treatment with combined treatment with ARB or analysis of the beta1-adrenergic receptor genotype may offer advantages to control congestive heart failure in the short-term.
Iwata
Atsushi
A
Department of Cardiology, Fukuoka University Hospital, Nanakuma 7-45-1, Jonan-ku, Fukuoka 814-0180.
Miura
Shin-ichiro
S
Nishikawa
Hiroaki
H
Kawamura
Akira
A
Matsuo
Yoshino
Y
Sako
Hideto
H
Kumagai
Koichiro
K
Matsuo
Kunihiro
K
Saku
Keijiro
K
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage*; D002227:Carbazoles / Q000008:administration & dosage*; D000077261:Carvedilol; D004359:Drug Therapy, Combination; D005260:Female; D014644:Genetic Variation; D006333:Heart Failure / Q000188:drug therapy* / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage*; D012189:Retrospective Studies
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol