Influence of pretreatment systolic blood pressure on the effect of carvedilol in patients with severe chronic heart failure: the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) study
We sought to evaluate the influence of pretreatment systolic blood pressure (SBP) on the efficacy and safety of carvedilol in patients with chronic heart failure (CHF). Although beta-blockers reduce the risk of death in CHF, there is little reported experience with these drugs in patients with a low...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2004-04, Vol.43 (8), p.1423-1429 |
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| container_title | Journal of the American College of Cardiology |
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| creator | Rouleau, Jean L Roecker, Ellen B Tendera, Michal Mohacsi, Paul Krum, Henry Katus, Hugo A Fowler, Michael B Coats, Andrew J S Castaigne, Alain Scherhag, Armin Holcslaw, Terry L Packer, Milton |
| description | We sought to evaluate the influence of pretreatment systolic blood pressure (SBP) on the efficacy and safety of carvedilol in patients with chronic heart failure (CHF).
Although beta-blockers reduce the risk of death in CHF, there is little reported experience with these drugs in patients with a low pretreatment SBP, who may respond poorly to beta-blockade.
We studied 2,289 patients with severe CHF who participated in the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial.
Compared with placebo, carvedilol improved the clinical status and reduced the risk of death and the combined risk of death or hospitalization for any reason, for a cardiovascular reason, or for worsening heart failure (p < 0.001 for all). The relative magnitude of these benefits did not vary as a function of the pretreatment SBP (all interaction: p > 0.10). However, because patients with the lowest SBP were at highest risk of an event, they experienced the greatest absolute benefit from treatment with carvedilol. The lower the pretreatment SBP, the more likely that patients would report an adverse event, be intolerant of high doses of the study drug, or require permanent withdrawal of treatment (p < 0.001 for all). However, these risks were primarily related to the severity of the underlying illness and not to treatment with carvedilol.
The current study provides little support for concerns about using beta-blockers (particularly those with vasodilatory actions) in patients with severe CHF who have a low SBP. Pretreatment blood pressure can identify patients who have the greatest need for risk reduction with carvedilol. |
| doi_str_mv | 10.1016/j.jacc.2003.11.037 |
| format | Article |
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Although beta-blockers reduce the risk of death in CHF, there is little reported experience with these drugs in patients with a low pretreatment SBP, who may respond poorly to beta-blockade.
We studied 2,289 patients with severe CHF who participated in the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial.
Compared with placebo, carvedilol improved the clinical status and reduced the risk of death and the combined risk of death or hospitalization for any reason, for a cardiovascular reason, or for worsening heart failure (p < 0.001 for all). The relative magnitude of these benefits did not vary as a function of the pretreatment SBP (all interaction: p > 0.10). However, because patients with the lowest SBP were at highest risk of an event, they experienced the greatest absolute benefit from treatment with carvedilol. The lower the pretreatment SBP, the more likely that patients would report an adverse event, be intolerant of high doses of the study drug, or require permanent withdrawal of treatment (p < 0.001 for all). However, these risks were primarily related to the severity of the underlying illness and not to treatment with carvedilol.
The current study provides little support for concerns about using beta-blockers (particularly those with vasodilatory actions) in patients with severe CHF who have a low SBP. Pretreatment blood pressure can identify patients who have the greatest need for risk reduction with carvedilol.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2003.11.037</identifier><identifier>PMID: 15093878</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Adrenergic beta-Antagonists - pharmacology ; Adrenergic beta-Antagonists - therapeutic use ; Aged ; Beta blockers ; Blood pressure ; Blood Pressure - drug effects ; Carbazoles - pharmacology ; Carbazoles - therapeutic use ; Cardiology ; Chronic Disease ; Drug therapy ; Female ; Heart attacks ; Heart Failure - drug therapy ; Heart Failure - mortality ; Heart Failure - physiopathology ; Humans ; Male ; Middle Aged ; Propanolamines - pharmacology ; Propanolamines - therapeutic use ; Prospective Studies ; Quality of life ; Retrospective Studies ; Survival Analysis ; Treatment Outcome ; Vasodilator Agents - therapeutic use</subject><ispartof>Journal of the American College of Cardiology, 2004-04, Vol.43 (8), p.1423-1429</ispartof><rights>Copyright Elsevier Limited Apr 21, 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15093878$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rouleau, Jean L</creatorcontrib><creatorcontrib>Roecker, Ellen B</creatorcontrib><creatorcontrib>Tendera, Michal</creatorcontrib><creatorcontrib>Mohacsi, Paul</creatorcontrib><creatorcontrib>Krum, Henry</creatorcontrib><creatorcontrib>Katus, Hugo A</creatorcontrib><creatorcontrib>Fowler, Michael B</creatorcontrib><creatorcontrib>Coats, Andrew J S</creatorcontrib><creatorcontrib>Castaigne, Alain</creatorcontrib><creatorcontrib>Scherhag, Armin</creatorcontrib><creatorcontrib>Holcslaw, Terry L</creatorcontrib><creatorcontrib>Packer, Milton</creatorcontrib><creatorcontrib>Carvedilol Prospective Randomized Cumulative Survival Study Group</creatorcontrib><title>Influence of pretreatment systolic blood pressure on the effect of carvedilol in patients with severe chronic heart failure: the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) study</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>We sought to evaluate the influence of pretreatment systolic blood pressure (SBP) on the efficacy and safety of carvedilol in patients with chronic heart failure (CHF).
Although beta-blockers reduce the risk of death in CHF, there is little reported experience with these drugs in patients with a low pretreatment SBP, who may respond poorly to beta-blockade.
We studied 2,289 patients with severe CHF who participated in the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial.
Compared with placebo, carvedilol improved the clinical status and reduced the risk of death and the combined risk of death or hospitalization for any reason, for a cardiovascular reason, or for worsening heart failure (p < 0.001 for all). The relative magnitude of these benefits did not vary as a function of the pretreatment SBP (all interaction: p > 0.10). However, because patients with the lowest SBP were at highest risk of an event, they experienced the greatest absolute benefit from treatment with carvedilol. The lower the pretreatment SBP, the more likely that patients would report an adverse event, be intolerant of high doses of the study drug, or require permanent withdrawal of treatment (p < 0.001 for all). However, these risks were primarily related to the severity of the underlying illness and not to treatment with carvedilol.
The current study provides little support for concerns about using beta-blockers (particularly those with vasodilatory actions) in patients with severe CHF who have a low SBP. Pretreatment blood pressure can identify patients who have the greatest need for risk reduction with carvedilol.</description><subject>Adrenergic beta-Antagonists - pharmacology</subject><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Aged</subject><subject>Beta blockers</subject><subject>Blood pressure</subject><subject>Blood Pressure - drug effects</subject><subject>Carbazoles - pharmacology</subject><subject>Carbazoles - therapeutic use</subject><subject>Cardiology</subject><subject>Chronic Disease</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Propanolamines - pharmacology</subject><subject>Propanolamines - therapeutic use</subject><subject>Prospective Studies</subject><subject>Quality of life</subject><subject>Retrospective Studies</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Vasodilator Agents - therapeutic use</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkd9q1UAQhxdR7Gn1BbyQBUH0InE3m2QT7yRUPVBsae112GxmyR422bh_Isc37Fu5rRXBq4GZ7_cxzCD0ipKcElp_OOQHIWVeEMJySnPC-BO0o1XVZKxq-VO0I5xVGSUtP0Gn3h8IIXVD2-fohFakZQ1vduhuvygTYZGArcKrg-BAhBmWgP3RB2u0xIOxdryfeR9d4hYcJsCgFMhwn5LCbTBqYw3WC15F0Cnu8U8dJuxhg5SRk7NLUk0gXMBKaJNMHx883b_0lbN-TVK9Ab4Wy2hn_QtG3MU5GvHQvYlu05sw-F13eXV-_W3f3d68xz7E8fgCPVPCeHj5WM_Q7efz793X7OLyy777dJFNBS9CVjesUUoJWpZMMk7aYmQMRg4V8JYVDRkrWQyK8oLIQnE2UF6LtpaiKKksm4Gdobd_vKuzPyL40M_aSzBGLGCj7zltSlo1bQLf_AcebHRL2q1P969pyXlJE_X6kYrDDGO_Oj0Ld-z_voj9Bl7zmBY</recordid><startdate>20040421</startdate><enddate>20040421</enddate><creator>Rouleau, Jean L</creator><creator>Roecker, Ellen B</creator><creator>Tendera, Michal</creator><creator>Mohacsi, Paul</creator><creator>Krum, Henry</creator><creator>Katus, Hugo A</creator><creator>Fowler, Michael B</creator><creator>Coats, Andrew J S</creator><creator>Castaigne, Alain</creator><creator>Scherhag, Armin</creator><creator>Holcslaw, Terry L</creator><creator>Packer, Milton</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20040421</creationdate><title>Influence of pretreatment systolic blood pressure on the effect of carvedilol in patients with severe chronic heart failure: the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) study</title><author>Rouleau, Jean L ; Roecker, Ellen B ; Tendera, Michal ; Mohacsi, Paul ; Krum, Henry ; Katus, Hugo A ; Fowler, Michael B ; Coats, Andrew J S ; Castaigne, Alain ; Scherhag, Armin ; Holcslaw, Terry L ; Packer, Milton</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-h272t-6838fffa1443c37092d33ed7e5e793280d5c2bf1720c2f73b176a96ca241c48b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adrenergic beta-Antagonists - pharmacology</topic><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Aged</topic><topic>Beta blockers</topic><topic>Blood pressure</topic><topic>Blood Pressure - drug effects</topic><topic>Carbazoles - pharmacology</topic><topic>Carbazoles - therapeutic use</topic><topic>Cardiology</topic><topic>Chronic Disease</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Propanolamines - pharmacology</topic><topic>Propanolamines - therapeutic use</topic><topic>Prospective Studies</topic><topic>Quality of life</topic><topic>Retrospective Studies</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Vasodilator Agents - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rouleau, Jean L</creatorcontrib><creatorcontrib>Roecker, Ellen B</creatorcontrib><creatorcontrib>Tendera, Michal</creatorcontrib><creatorcontrib>Mohacsi, Paul</creatorcontrib><creatorcontrib>Krum, Henry</creatorcontrib><creatorcontrib>Katus, Hugo A</creatorcontrib><creatorcontrib>Fowler, Michael B</creatorcontrib><creatorcontrib>Coats, Andrew J S</creatorcontrib><creatorcontrib>Castaigne, Alain</creatorcontrib><creatorcontrib>Scherhag, Armin</creatorcontrib><creatorcontrib>Holcslaw, Terry L</creatorcontrib><creatorcontrib>Packer, Milton</creatorcontrib><creatorcontrib>Carvedilol Prospective Randomized Cumulative Survival Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rouleau, Jean L</au><au>Roecker, Ellen B</au><au>Tendera, Michal</au><au>Mohacsi, Paul</au><au>Krum, Henry</au><au>Katus, Hugo A</au><au>Fowler, Michael B</au><au>Coats, Andrew J S</au><au>Castaigne, Alain</au><au>Scherhag, Armin</au><au>Holcslaw, Terry L</au><au>Packer, Milton</au><aucorp>Carvedilol Prospective Randomized Cumulative Survival Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of pretreatment systolic blood pressure on the effect of carvedilol in patients with severe chronic heart failure: the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) study</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2004-04-21</date><risdate>2004</risdate><volume>43</volume><issue>8</issue><spage>1423</spage><epage>1429</epage><pages>1423-1429</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>We sought to evaluate the influence of pretreatment systolic blood pressure (SBP) on the efficacy and safety of carvedilol in patients with chronic heart failure (CHF).
Although beta-blockers reduce the risk of death in CHF, there is little reported experience with these drugs in patients with a low pretreatment SBP, who may respond poorly to beta-blockade.
We studied 2,289 patients with severe CHF who participated in the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial.
Compared with placebo, carvedilol improved the clinical status and reduced the risk of death and the combined risk of death or hospitalization for any reason, for a cardiovascular reason, or for worsening heart failure (p < 0.001 for all). The relative magnitude of these benefits did not vary as a function of the pretreatment SBP (all interaction: p > 0.10). However, because patients with the lowest SBP were at highest risk of an event, they experienced the greatest absolute benefit from treatment with carvedilol. The lower the pretreatment SBP, the more likely that patients would report an adverse event, be intolerant of high doses of the study drug, or require permanent withdrawal of treatment (p < 0.001 for all). However, these risks were primarily related to the severity of the underlying illness and not to treatment with carvedilol.
The current study provides little support for concerns about using beta-blockers (particularly those with vasodilatory actions) in patients with severe CHF who have a low SBP. Pretreatment blood pressure can identify patients who have the greatest need for risk reduction with carvedilol.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>15093878</pmid><doi>10.1016/j.jacc.2003.11.037</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adrenergic beta-Antagonists - pharmacology Adrenergic beta-Antagonists - therapeutic use Aged Beta blockers Blood pressure Blood Pressure - drug effects Carbazoles - pharmacology Carbazoles - therapeutic use Cardiology Chronic Disease Drug therapy Female Heart attacks Heart Failure - drug therapy Heart Failure - mortality Heart Failure - physiopathology Humans Male Middle Aged Propanolamines - pharmacology Propanolamines - therapeutic use Prospective Studies Quality of life Retrospective Studies Survival Analysis Treatment Outcome Vasodilator Agents - therapeutic use |
| title | Influence of pretreatment systolic blood pressure on the effect of carvedilol in patients with severe chronic heart failure: the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) study |
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