Differential beta-adrenoblocker therapy in chronic heart failure: the role of age, gender, and co-morbidity

Aim. To investigate differential beta-adrenoblocker (BAB) therapy, based on clinical and demographic characteristics of the patients, as a method to optimise the management of chronic heart failure (CHF).

Material and methods. The study included 90 patients: 50 men (55,6%) and 40 women (44,4%) of mean age 64,7±1,9 years. The participants stopped taking the previously prescribed BAB and two weeks later, they were randomly divided into three groups. Group I (n=30) received bisoprolol (starting dose — 2,5 mg once a day, maximal dose — 50 mg/d). Group II (n=30) received carvedilol (initial dose — 12,5 mg/d, maximal dose — 50 mg/d). Group III (n=30) was administered nebivolol (starting and maximal doses — 2,5 mg/d and 10 mg/d, respectively). At baseline and 6 months later, all participants underwent echocardiography (EchoCG), assessing ejection fraction, diastolic dysfunction presence and type. Increased functional class (FC) of CHF was regarded as disease progression, and reduced FC — as disease regression. The levels of neuro-hormones and brain natri­uretic peptide (BNP) were also measured. Treatment effectiveness was assessed by efficacy and safety parameters in combination.

Results. No inter-group differences were observed for central hemodynamics, EchoCG parameters and neuro­hormone levels. Nebivolol was particularly effective in chronic renal failure, anaemia, in elderly patients and women. In other patient groups, bisoprolol was the most effective agent. The main laboratory parameter determining BAB choice, was aldosterone, followed by pro-BNP (a=0,049). Noradrenalin levels should not be used for choosing BAB.

Conclusion. Considering the fact that aldosterone, noradrenalin and pro-BNP level measurement is not a part of routine clinical practice, and could not be easily implemented into real-world clinical settings, the parameters determining BAB choice could be the patient’s age, gender, and co-morbidities.

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