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 journalArticle

19 Citations (Scopus)

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

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Angiotensin-Converting Enzyme Inhibitors
Angiotensin Receptor Antagonists
Systolic Heart Failure
Odds Ratio
Placebos
Confidence Intervals
Heart Failure
Hospitalization
Mortality
Therapeutics
Meta-Analysis
Cause of Death
Organizations
Prospective Studies

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Krum, H., Haas, S. J., Eichhorn, E., Ghali, J., Gilbert, E., Lechat, P., ... Wikstrand, J. (2005). Prognostic benefit of beta-blockers in patients not receiving ACE-Inhibitors. European Heart Journal, 26(20), 2154-2158. https://doi.org/10.1093/eurheartj/ehi409

Prognostic benefit of beta-blockers in patients not receiving ACE-Inhibitors. / Krum, Henry; Haas, Steven Joseph; Eichhorn, Eric; Ghali, Jalal; Gilbert, Edward; Lechat, Philippe; Packer, Milton; Roecker, Ellen; Verkenne, Patricia; Wedel, Hans; Wikstrand, John.

In: European Heart Journal, Vol. 26, No. 20, 10.2005, p. 2154-2158.

Research output: Contribution to journalArticle

Krum, H, Haas, SJ, Eichhorn, E, Ghali, J, Gilbert, E, Lechat, P, Packer, M, Roecker, E, Verkenne, P, Wedel, H & Wikstrand, J 2005, 'Prognostic benefit of beta-blockers in patients not receiving ACE-Inhibitors', European Heart Journal, vol. 26, no. 20, pp. 2154-2158. https://doi.org/10.1093/eurheartj/ehi409
Krum H, Haas SJ, Eichhorn E, Ghali J, Gilbert E, Lechat P et al. Prognostic benefit of beta-blockers in patients not receiving ACE-Inhibitors. European Heart Journal. 2005 Oct;26(20):2154-2158. https://doi.org/10.1093/eurheartj/ehi409
Krum, Henry ; Haas, Steven Joseph ; Eichhorn, Eric ; Ghali, Jalal ; Gilbert, Edward ; Lechat, Philippe ; Packer, Milton ; Roecker, Ellen ; Verkenne, Patricia ; Wedel, Hans ; Wikstrand, John. / Prognostic benefit of beta-blockers in patients not receiving ACE-Inhibitors. In: European Heart Journal. 2005 ; Vol. 26, No. 20. pp. 2154-2158.
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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.",
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AU - Krum, Henry

AU - Haas, Steven Joseph

AU - Eichhorn, Eric

AU - Ghali, Jalal

AU - Gilbert, Edward

AU - Lechat, Philippe

AU - Packer, Milton

AU - Roecker, Ellen

AU - Verkenne, Patricia

AU - Wedel, Hans

AU - Wikstrand, John

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N2 - 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.

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