Russian Heart Failure Journal 2009year Effectiveness of outpatient switching patients with chronic heart failure from «not recommended» for this disease β-adrenoblockers to nebivolol or bisoprolol


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2009/

Effectiveness of outpatient switching patients with chronic heart failure from «not recommended» for this disease β-adrenoblockers to nebivolol or bisoprolol

Zhubrina E. S., Ovchinnikov A. G., Seredinina E. M., Blankova Z. N., Masenko V. P., Heymets G. I., Ageev F. T.

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Urgency. A beneficial effect on the CHF course and prognosis has been demonstrated for only a small number of β-adrenoblockers (BAB). In clinical practive, nevertheless, many patients still stay on BAB with not proven or questionable efficacy in CHF. Aim. Evaluating the effectiveness of switching patients with CHF from the “not recommended” BAB to bisoprolol or nebivolol. Materials and methods. 67 patients with stable II-III FC CHF who had received a standard therapy for CHF including “not recommended” BABs were randomized to bisoprolol (n=35) or nebivolol (n=32) in doses of 1.25 to 10 mg/day (depending on individual tolerance). Clinical status and quality of life (using the Minnesota questionnaire and the visual analogue scale) were assessed in all patients at baseline and after 6 months of therapy. Also a 6-min walking test was performed, echoCG was recorded (to evaluate LV EF), and the serum level of N-terminal pro-brain natriuretic peptide (NT-proBNP) was measured. Results. Switching patients from “not recommended” BAB to bisoprolol and nebivolol was associated with a significant decrease in mean CHF FC; an increase in 6-min walking distance; an improvement in all parameters of quality of life, and an increase in LV EF (for all cases, р<0.01 compared to baseline). Despite that NT-proBNP remained virtually unchanged in all patients, a significant decrease in this parameter (p<0.05) was observed in a subgroup of patients with high baseline NT-proBNP levels (above median). Significant differences in effects on all studied parameters between nebivolol and bisoprolol treatment groups were absent. Therefore switching patients with CHF from “not recommended” BAB to nebivolol or bisoprolol was associated with improvements in their condition, quality of life, LV systolic function, and with reduced levels of NT-proBNP in patients with high levels of this peptide.
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