Effects of Controlled-Release Metoprolol on Total Mortality, Hospitalizations, and Well-being in Patients with Heart Failure: The Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF)

Hjalmarson, Å; Fagerberg, Sidney Goldstein Björn; Wredel, Hans; Waagstein, Finn; Kjekshus, John; Wikstrand, John; Allaf, Dia El; Vítovec, Jiří; Aldershivile, Jan; Halinen, Matti; Dietz, Rainer; Neuhaus, Karl-Ludwig; Jánosi, András; Þorgeirsson, Guðmundur; Dunselman, Peter H.J.M.; Gullestad, Lars; Kuch, J; Herlitz, Johan; Rickenbacher, Peter; Ball, Stephen; Gottlieb, Stephen S.

doi:10.1097/00132586-200012000-00023

Cited by 421 publications

(557 citation statements)

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“…29 Left ventricular hypertrophy can be reduced by the peripheral and coronary vasodilating effect of ␣-blockade. 11,28,30 The beneficial effect of adrenergic suppression on mortality and hospitalization rates in adults has been demonstrated in several large-scale studies with metoprolol 13,14 and bisoprolol. 15,16 In adults with CHF who were treated with digoxin, diuretics and ACE inhibitors, the addition of carvedilol significantly reduced mortality and hospitalization rates.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies 8 -10 in adult patients have suggested that sympathetic activation plays an important role in the genesis and progression of heart failure. This, combined with the results of several clinical trials, [11][12][13][14][15][16] has led to the addition of ␤-sympathetic antagonists to the armamentarium of pharmacologic treatments for heart failure in adults. Carvedilol is a third generation non-selective ␤-antagonist with ␣ 1 -adrenergic blocking and anti-oxidant activity.…”

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confidence: 99%

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Carvedilol in children with cardiomyopathy: 3-year experience at a single institution

Rusconi

Gómez-Marı́n

Rossique-Gonzalez

et al. 2004

The Journal of Heart and Lung Transplantation

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Background: Carvedilol reduces mortality and hospitalization in adults with congestive heart failure. Limited information is available about its use in children. Methods:We reviewed the medical records of 24 children with dilated cardiomyopathy and left ventricular ejection fraction of Յ40%, who were treated with carvedilol as adjunct therapy to angiotensinconverting enzyme inhibitors, digoxin and diuretics. Results:Carvedilol was initiated 14.3 Ϯ 23.3 (mean Ϯ SD) months after the diagnosis of cardiomyopathy. Mean age at initiation of therapy was 7.2 Ϯ 6.4 years. The mean initial and maximum doses were 0.15 Ϯ 0.09 and 0.98 Ϯ 0.26 mg/kg/day. Adverse effects occurred in 5 patients (21%). Two patients (8%) required discontinuation of the drug within 5 weeks of the initial dose. The remaining 22 patients tolerated carvedilol for a mean follow-up period of 26.6 Ϯ 14.7 months. Among these 22 patients, mean left ventricular ejection fraction improved from 24.6 Ϯ 7.6% to 42.2 Ϯ 14.2% (p Ͻ 0.001), and mean sphericity index from 0.86 Ϯ 0.11 to 0.74 Ϯ 0.10 (p Ͻ 0.001). New York Heart Association functional class improved in 15 patients (68%). One patient (4%) died and 3 (14%) were transplanted. Conclusions: Carvedilol, in addition to standard therapy for dilated cardiomyopathy in children improves cardiac function and symptoms; it is well tolerated, with minimal adverse effects, but close monitoring is necessary as it might worsen congestive heart failure and precipitate asthma. Control studies are necessary to assess the effect of carvedilol on mortality and hospitalization rates.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Carvedilol in children with cardiomyopathy: 3-year experience at a single institution

Rusconi

Gómez-Marı́n

Rossique-Gonzalez

et al. 2004

The Journal of Heart and Lung Transplantation

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“…In the case of chronic HF following hospitalization, published meta-analyses of randomized, controlled clinical trials were abstracted for outcome data, and descriptions of the interventions were applied (20)(21)(22)(23)(24)(25). These data were collated, and the timing of intervention was documented.…”

Section: Methodsmentioning

confidence: 99%

Treating the right patient at the right time: Access to heart failure care

Ross¹,

Howlett²,

Arnold³

et al. 2006

Canadian Journal of Cardiology

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“…Beta-receptor blockers have been around for more than 35 years in cardiovascular medicine, 1 and used for a variety of conditions including treatment of hypertension, 2,3 congestive heart failure, 4,5 migraine, [6][7][8] heart palpitations and other cardiac arrhythmias, [9][10][11] and as secondary prevention [12][13][14] following myocardial infarction. Recently, two sets of meta-analyses published in the Lancet 15,16 have cast doubts on the usefulness of beta-receptor blockers for use in essential hypertension.…”

mentioning

confidence: 99%

“…For at least two of these conditions, beta-receptor blocker therapy has shown evidence of benefit, for example, with metoprolol in prevention of carotid intima media thickness progression in the BCAPS trial, 20 as well as in the treatment of congestive heart failure. 4,5 It is interesting to note that beta-blockers may show clinical benefits also in patients with diabetes, in spite of the fact that insulin sensitivity and glucose metabolism might be impaired, 21 as shown in the MERIT-HF trial for treatment of congestive heart failure by metoprolol 22 and in the UKPDS Hypertension arm by atenolol treatment compared to captopril. 23 In these studies, a large proportion of included patients have had hypertension.…”

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confidence: 99%

Beta-receptor blockers in primary prevention for cardiovascular disease: forgotten benefits?

Nilsson

Berglund

2006

J Hum Hypertens

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Beta-receptor blockers have been around for more than 35 years in cardiovascular medicine, 1 and used for a variety of conditions including treatment of hypertension, 2,3 congestive heart failure, 4,5 migraine, 6-8 heart palpitations and other cardiac arrhythmias, 9-11 and as secondary prevention [12][13][14] following myocardial infarction. Recently, two sets of meta-analyses published in the Lancet 15,16 have cast doubts on the usefulness of beta-receptor blockers for use in essential hypertension. These doubts were first raised for atenolol, 15 but then expanded to include also other beta-receptor blockers based on meta-analyses of 13 trials. 16 Even if it is fully appropriate that from time to time to make critical analyses of established dogmas and therapies in medicine, we feel that not all arguments have been voiced in defence of betareceptor blocker therapy for essential hypertension. In order to make the current debate on the role of beta-receptor blockers more multidimensional, we wanted to scrutinize the arguments against the beta-receptor blockers and to put forward some arguments in defence of this therapy.First of all, drugs are not only prescribed for more or less abstract risks in the future, but to patients presenting from symptoms in everyday life related to real health problems. Even if some individuals will not be able to tolerate beta-receptor blockers owing to side effects, it is a well-documented clinical experience that many patients suffering from migraine, heart palpitations or anxiety may feel symptomatic relief after starting beta-receptor blocker therapy. [6][7][8][9][10][11] This is a clinical argument that should not be overlooked, especially as many general practitioners face patients with a variety of symptoms presented at the consultation, not only the more or less precisely measured blood pressure value that will eventually qualify for antihypertensive treatment.Secondly, we know that during 35 years of development, we have seen a number of different beta-receptor blockers, ranging from the older nonselective ones (e.g. propranolol, oxprenolol) to the more modern, selective ones (atenolol, metoprolol), and with dual receptor-mediated effects (carvedilol, bisoprolol). During this development, there has also been one example of a beta-receptor blocker (practolol) that was stopped due to serious adverse effects in the early 1970s. This is to say that the beta-receptor blockers are not created all the same, and thus differ in chemical properties, lipidophilic structure and specificity for the beta-adrenergic receptor. 17 New data have also shown that the genetic background of the patient may determine clinical effects on glucose metabolism and lipid levels in patients receiving beta-receptor blocker therapy. 18 This class of drugs is therefore heterogeneous, both in a pharmacological sense and in the individual clinical effects when given to patients.Thirdly, a substantial proportion of patients with so-called essential hypertension may in fact have target organ damage 19 including...

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Effects of Controlled-Release Metoprolol on Total Mortality, Hospitalizations, and Well-being in Patients with Heart Failure: The Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF)

Cited by 421 publications

References 0 publications

Carvedilol in children with cardiomyopathy: 3-year experience at a single institution

Carvedilol in children with cardiomyopathy: 3-year experience at a single institution

Treating the right patient at the right time: Access to heart failure care

Beta-receptor blockers in primary prevention for cardiovascular disease: forgotten benefits?

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