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Chronic Therapy with Beta-Adrenergic Receptor Blockers Improves Endothelial Function in Patients with Chronic Heart Failure: Presented at HFSA
By Gina Alexis
Special to DG News
BOCA RATON, FL -- September 30, 2002 - Endothelial function appears to be improved in congestive heart failure patients receiving ongoing treatment with beta-adrenergic receptor blockers.
The findings were reported here September 23rd at the 6th annual Heart Failure Society of America meeting (HFSA).
Researchers from Yale University School of Medicine, New Haven, Connecticut, and Columbia University College of Physicians and Surgeons, New York, United States, studied eighteen men and three women (mean age of 54 years) with New York Heart Association (NYHA) Class I-III congestive heart failure (CHF), who were treated with ACE Inhibitors, digoxin and diuretics. All patients had ejection fractions of less than 40 percent.
These ambulatory patients with stable CHF were divided into two groups; 11 patients were given a mean daily dose of 39 mg of carvedilol, and 10 patients received a mean dose of 150 mg of long-acting metoprolol. Measurements were performed before and after six months of treatment with these medications.
Plasma norepinephrine levels were measured by high-pressure liquid chromatography and flow-mediated dilation (FMD) was determined with high-resolution ultrasonographic imaging of the brachial artery.
After six months of beta-blocker treatment, baseline-resting diameter of brachial artery did not change (4.109 mm versus 4.110mm). Flow-mediated dilation increased form 1.67 percent before treatment to 3.42 percent after (p=0.07). Plasma norepinephrine levels decreased from 591 pg/mL before treatment to 426 pg/mL after six months of beta-blockade (p<0.05).
After six months of treatment, patients in the metoprolol group had significantly increased FMD from 0.25 percent before treatment to 3.66 percent after (p<0.05). In the carvedilol group, FMD did not change with treatment (2.88 percent versus 2.98 percent).
In pre-treatment with metoprolol, plasma norepinephrine levels decreased significantly from 550 pg/mL to 397 pg/mL post-treatment. Likewise, these measurements also decreased in the carvedilol group from 626 pg/mL before treatment and 450 pg/mL after, p<0.05.
Researchers concluded, "Chronic treatment with beta-adrenergic receptor blockers is associated with a marginally significant increase in endothelial function in the peripheral vasculature in patients with CHF."
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