Clinical Effects Of Betaloc On Stable Chronic Congestive Heart Failure

Background and ObjectiveCongestive heart failure(CHF) is a clinical progressing syndromeresulting from a great deal of pathophsiological processes due tocardiac illness. The main points: the presence of a specific cardiacdisease and mismatch of cardiac performance for a givencellular/metabolic requirement. The morbidity and mortality of CHFis remaining increasing, which has been the main cause of allcardiovascular death incidents. The traditional mode using digitalisand diuretic do not attain contentment in increasing mortality andeffects. Recently abroad using of angiotensin-converting enzyme(ACE)inhibitors have already changed the prognosis of partial patients withCHF, but according clinical data, the mortality of CHF is still high.Presently standard treatment includes ACE inhibitors, diureticsand/or digitalis. The improvement after taking ACEI is limited inmajority patients with CHF, because the standard treatment can'tprevent sudden death or arrhythmic death caused by CHF. It is alreadyillustrated that the occurring and development of CHF is closelyrelated to over-activity of renin-angiotensin system(RAS) andsympathetic nervous system. In condition of dysfunction or HF, thenervous system acts as an important role compensating of meeting anemergency, but in the long run, the abnormality of RAS,sympatheticnervous system and other neurohormanes would do harm to the patients.The over excitement can lead to CHF pathophsiological processincluding β-adrenergic receptor down-regulation and target proteinhyperphosphorylation in cardioimyocytes and direct toxicity tocardiomyocytes, and causing severe arrhythmia. The rationality ofusing metoprolol(Betaloc) to treat CHF is to prevent the deterioratingimpact of abnormal neurohormone transduced by β1-adrenergic receptorin cadiomyocytes. In some trials, treatment of metoprolol show benefitfor improvements of left ventricular function and clinical symptom.Now most physician prove to use β-adrenergic antangonists to treatCHF of all causes(including ischemic heart disease). In our nationit is absence in studying of β-adrenergic antangonists to treatChinese patients with stable CHF of all causes about effects andtolerability and survival.Methods: We choose forty patients with stable CHF of left ventricularejection fraction(LVEF) < 40%,NYHA Ⅱ-Ⅳ(New York HeartAssociation),grouping them randomly on the basis of standard CHFtreatment(ACEI and diuretic ,digitalis ,vasodilator innecessary).Intervention group is of standard treatment plusmetoprolol(Betaloc), and comparison group is of standard treatment.Being candidate, each must have evidence of EF<40%,and symptoms andexaminations of CHF. Metoprolol(Betaloc) should initiate at6.25mg/d,b.i.d..It is recommended that the dose be doubled after2-week period until the target daily dose of 200mg/d of metoprololwas reached.This regimen could be modified according to the judgmentof the investigator. Then maintain the dose of target dose or themaximal dose tolerated. In maintaining phase visit the patient once3 months. And in titration phase every-two-week visit would estimatethe tolerability of metoprolol in the last two weeks, and physician...