Clinical Trial Of Cavedilol In Treatment Of Chronic Congestive Heart Failure

1. BackgroudCongestive heart failure(CHF) is a high-death-rate syndrome caused by all kinds of cardiac diseases. It characterized as congestion in vein system , ischemia in artery system , hypoxia and ischemia in tissues and organs, while its hypostasis is the cardiac output can't meet the needs of organism metabolism because of the decrease of myocardium contractility. CHF is the final result of some cardiac diseases such as coronary heart disease(CHD), hypertensive heart disease(HHD), dilated cardiomyopathy (DCM), and rheumatic heart disease(RHD). There are lots of pathogenice factors in the whole pathophysiological process of CHF. Some researches showed that sympathetic nervous system(SNS) and RAS play an important role in occurrence and development of CHF. The application of beta-blockers is a new starting in the treatment of CHF. As a 3rd beta-blockers, Carvedilol has been paid more attention for its special pharmacological function. However its effects, safety and tolerance in the treatment of CHF need further evaluation.2. Objective To evaluate the effects, safety and tolerance of Carvedilol in the treatment of CHF.3. Methods75 CHF patients (New York Heart Association functional class II-IV) were randomly divided into two groups. One was conventional treatment group( n = 29 ) treated with cardiac tonic, diuretics, and vasodilatation including ACEI; The other was caverdilol treatment group ( n = 43 ) treated with carvedilol and conventional therapy. The patients in the treatment group were given carvedilol at the beginning dose of 5mg/d and was slowly titrated to 40mg/d as tolerated or to the dose can be just tolerated. Echocardiogram, blood biochemical examination were done before and after treatment. Clinical effect, safety and tolerance was evaluated, and Clinical effect, safety and tolerance was evaluated after treatment. 4. Result 4.1 Clinical efficacy rate (based on NYHA Class): Carvedilol group was 87.5%, while conventional group was 65.5%. There were significant differences between the two groups ( P < 0.01).4.2 Data of cardiac shape and function by echocardiography such as LVDD, LVDS, IVS, LVPW, LVESV, LVEDV, LVEF: after the treatment the data above were significant amelioration in the two groups, and the effect of carvedilol group was better than that of conventional group (P < 0.05). 4.3 Side effects and safety: dizziness, nausea and coughing were main side effects in the carvedilol group. There were no significant differences between the two groups in the side effect rate. No obvious changes of lever, renal function, electrolyte and blood sugar were found in both groups.4.4 Tolerance: the patients had better tolerance towards carvedilol, and the average tolerant dose was 22.5±2.5mg/d 5. Conclusion In this study we can conclude that carvedilol had a cardiac protective effect in patients with CHF for its improving cardiac function and decreasing ventricular remodeling progress. It has less side effect, better tolerance and higher safety than conventional drug.