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Is target dose the treatment target? Uptitrating beta-blockers for heart failure in the elderlyGelbrich, Götz ...Background: Guideline-recommended beta-blocker (BB) target doses for patients with chronic heart failure can often not be reached. This secondary analysis of the CIBIS-ELD trial was carried out to ... better understand reasons for not achieving target doses. Methods: Changes in heart rate (HR) and other parameters during a 12-week up-titration period in 302 BB naive patients wereevaluated in the subgroups achieving 12.5, 25, 50, and 100% of the target dose (groups 1, 2, 3, and 4, respectively). Results: Achieved doses predominantly depended on baseline HR (means 68, 74, 76, and 84bpm in groups 1-4, respectively, P<0.001). HR was consistently reduced with each dose level to 65, 63, and 62bpm in groups 1-3 and to 71bpm in group 4 (P<0.001). When adjusted for baseline, HR reduction achieved in group 3 was better than in group 4 (difference -5.4bpm, P<0.05). More patients in groups 3/4 than in groups 1/2 improved in NYHA class (P=0.01). NTproBNP increased by 38% in group4 (P<0.01) but not in the others (P<0.05 between groups). Changes in blood pressure, six-minute walk distance and self-rated health were comparablein all groups. Conclusions: The desired effect of HR reduction appears to be a predominant limitation for BB up-titration. Vice versa, achieving the target dose may be a sign of insufficient response rather than successful treatment. In view of these results and the well-known importance of HR for survival, not target doses, but HR control should be given priority in BB treatment for heart failure.Source: International journal of cardiology. - ISSN 0167-5273 (Vol. 155, iss. 1, 2012, str. 160-166)Type of material - article, component partPublish date - 2012Language - englishCOBISS.SI-ID - 29340633
Author
Gelbrich, Götz |
Edelmann, Frank |
Inkrot, Simone |
Lainščak, Mitja
Other authors
CIBIS-ELD investigators
Topics
Heart Failure, Congestive |
Diet Therapy |
Adrenergic Beta-Antagonists |
Administration And Dosage |
Heart Rate |
Follow-Up Studies |
Aged |
Practice Guidelines |
Srčna frekvenca |
Starostniki |
Srce, odpoved kongestivna |
Adrenergični beta-antagonisti |
Sledilne študije |
Praktična navodila
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Gelbrich, Götz | ![]() |
Edelmann, Frank | ![]() |
Inkrot, Simone | ![]() |
Lainščak, Mitja | 22680 |
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