Prognostic benefit of beta-blockers in patients not receiving ACE-Inhibitors

Henry Krum, Steven Joseph Haas, Eric Eichhorn, Jalal Ghali, Edward Gilbert, Philippe Lechat, Milton Packer, Ellen Roecker, Patricia Verkenne, Hans Wedel, John Wikstrand

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Aims: Beta-blockers (BBs) confer significant prognostic benefit in patients (pts) with systolic chronic heart failure (CHF). However, major trials have thus far studied BBs mainly in addition to ACE-Inhibitors or angiotensin receptor blockers (ARBs) as background therapy. The magnitude of the prognostic benefit of BBs in the absence of ACE-I or ARB has not as yet been determined. Methods and results: We performed a meta-analysis of all placebo-controlled BB studies in patients with CHF (n > 200). Trials were identified via Medline literature searches, meeting abstracts, and contact with study organizations. Results for all-cause mortality and death or heart failure hospitalization were pooled using the Mantel-Haenszel (fixed effects) method. The impact of BB therapy on all-cause mortality in CHF, in the absence (4.8%) and presence (95.2%) of ACE-I (or ARB), was determined from six trials of 13 370 patients. The risk ratio (RR) for BBs vs. placebo was 0.73 [95% confidence interval (CI) 0.53-1.02] in the absence of ACE-I or ARB at baseline, compared with a RR of 0.76 (95% CI 0.71-0.83) in the presence of these agents. When ACE-Inhibitors were analysed in the same way (pre-BB), a RR of 0.89 (0.80-0.99) vs. placebo was observed in studies of >90 days. The impact of BB therapy on death or HF hospitalization in systolic CHF, in the absence and presence of ACE-I, was determined from three trials of 8988 patients. The RR for BBs vs. placebo was 0.81 (95% CI 0.61-1.08) in the absence of ACE-I or ARB at baseline, compared with a RR of 0.78 (95% CI 0.74-0.83) in the presence of these agents. When ACE-Is were analysed in the same way (pre-BB), a RR of 0.85 (95% CI 0.78-0.93) vs. placebo was observed in studies of >90 days. Conclusion: The magnitude of the prognostic benefit conferred by BBs in the absence of ACE-I appears to be similar to those of ACE-Is in systolic CHF. These data therefore suggest that either ACE-Is or BBs could be used as first-line neurohormonal therapy in patients with systolic CHF. Prospective studies directly comparing these agents are required to definitively address this issue.

Original languageEnglish (US)
Pages (from-to)2154-2158
Number of pages5
JournalEuropean heart journal
Volume26
Issue number20
DOIs
StatePublished - Oct 2005

Keywords

  • ACE-Inhibitor
  • Beta-blocker
  • Chronic heart failure
  • Hospitalization
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Prognostic benefit of beta-blockers in patients not receiving ACE-Inhibitors'. Together they form a unique fingerprint.

Cite this