阿替洛尔β1受体阻滞对接受大剂量依那普利预处理的患者心力衰竭进展的影响。

Effect of beta 1 blockade with atenolol on progression of heart failure in patients pretreated with high-dose enalapril.

作者信息

Sturm B, Pacher R, Strametz-Juranek J, Berger R, Frey B, Stanek B

机构信息

Department of Cardiology, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.

出版信息

Eur J Heart Fail. 2000 Dec;2(4):407-12. doi: 10.1016/s1388-9842(00)00120-3.

DOI:10.1016/s1388-9842(00)00120-3

PMID:11113718

Abstract

BACKGROUND

The survival benefit of beta-blocker treatment in patients with heart failure has been established in recent trials. Yet, the impact of beta-blockers added on high dose angiotensin converting enzyme inhibitors has not been reported.

AIMS

To investigate the effect of atenolol, a hydrophilic, selective beta1-adrenergic antagonist, added on enalapril 40 mg/day in patients with advanced left ventricular dysfunction in a double-blind placebo-controlled trial.

METHODS

One hundred and nineteen patients with class II or III heart failure, left ventricular ejection fraction < or = 25% and treatment with 40 mg enalapril daily were given an initial challenge dose of atenolol 12. 5 mg. One hundred patients (54 with idiopathic, 28 with ischemic, 18 with other dilated cardiomyopathy) tolerated challenge and were randomized to atenolol (maintenance dose 89+/-11 mg/day, range 50-100 mg/day) or placebo. The primary endpoint was combined worsening heart failure or death within 2 years, the secondary endpoint was hospitalization for cardiac events.

RESULTS

After 395+/-266 days interim analysis revealed a significant difference between the atenolol and placebo group (log rank P<0.01) and the trial was concluded. Twenty-seven patients had developed worsening heart failure (8 in the atenolol group vs. 19 in the placebo group) and 13 patients had died (5 in the atenolol vs. 8 in the placebo group). Overall there were 23 hospitalizations for cardiac events (6 in the atenolol group vs. 21 in the placebo group, P=0.07); 17 hospitalizations were due to worsening heart failure (5 in the atenolol group, 12 in the placebo-group, P=0.05) and 10 due to arrhythmias (1 in the atenolol group vs. 9 in the placebo group, P<0.01)

CONCLUSIONS

The data suggest that in patients with advanced left ventricular dysfunction, beta-blockers can provide substantial benefits supplementary to that already achieved with high dose enalapril treatment.

摘要

背景

近期试验已证实β受体阻滞剂治疗对心力衰竭患者的生存益处。然而，关于在高剂量血管紧张素转换酶抑制剂基础上加用β受体阻滞剂的影响尚未见报道。

目的

在一项双盲安慰剂对照试验中，研究亲水性选择性β1肾上腺素能拮抗剂阿替洛尔加用至每日40毫克依那普利对晚期左心室功能不全患者的影响。

方法

119例Ⅱ级或Ⅲ级心力衰竭、左心室射血分数≤25%且每日接受40毫克依那普利治疗的患者，给予初始冲击剂量阿替洛尔12.5毫克。100例患者（54例特发性、28例缺血性、18例其他扩张型心肌病）耐受冲击并被随机分为阿替洛尔组（维持剂量89±11毫克/天，范围50 - 100毫克/天）或安慰剂组。主要终点为2年内心力衰竭恶化或死亡的复合终点，次要终点为因心脏事件住院。

结果

经过395±266天的中期分析显示，阿替洛尔组与安慰剂组之间存在显著差异（对数秩检验P<0.01），试验结束。27例患者出现心力衰竭恶化（阿替洛尔组8例，安慰剂组19例），13例患者死亡（阿替洛尔组5例，安慰剂组8例）。总体上有23次因心脏事件住院（阿替洛尔组6次，安慰剂组21次，P = 0.07）；17次住院是由于心力衰竭恶化（阿替洛尔组5次，安慰剂组12次，P = 0.05），10次是由于心律失常（阿替洛尔组1次，安慰剂组9次，P<0.01）。