[Chronic heart failure treatment in uremic patients with beta-blockers].
The interpretation of congestive heart failure (CHF) in '80 was exclusively in haemodynamic terms. In accordance with such a pathophysiologic hypothesis, cardiovascular drugs, mainly positive inotropics and/or vasodilators were experimented with not significative results. From the second half of the 80's the attention starts focusing on the neurohumoral asset, strongly activated in patients suffering from CHF and that was it selves cause of worsening of CHF and responsible for the poor prognosis of these patients, so as to become therapeutic targets and to represent the rationale for using ace-inhibitors (ACE-I), betablockers and angiotensin II receptor blockers (ARBs). Evidence has been provided that these drugs can reduce morbidity and mortality. However, this evidence derives only from studies on general population. In uraemic patients there are no controlled trials dedicated and the nephrological guidelines recommends the use of ACE-I on the hypothesis that they may have similar efficacy than non uremic patients. Among all the medications used to treat CHF in the general population, only betablockers has been shown to be effective in a randomized trial in the dialysis population. Carvedilol was found to improve left ventricular function and decrease hospitalization, cardiovascular deaths and total mortality, remarking that pathophysiology, rationale for using and results may be similar in uremic and non uremic patients suffering from CHF.
Cice
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Cattedra di Cardiologia, Seconda Università degli Studi di Napoli, Napoli-Italy. gennarocice@hotmail.com
D'Isa
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D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002908:Chronic Disease; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D014511:Uremia / Q000150:complications*
D000319:Adrenergic beta-Antagonists