Prognostic benefit of beta-blockers in patients not receiving ACE-Inhibitors
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Le résumé fourni par la source
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.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Prognostic benefit of beta-blockers in patients not receiving ACE-Inhibitors
- Date Crossref
- 13/07/2005
- Éditeur
- Oxford University Press (OUP)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Monash Alfred Psychiatry Research centre pays non établi dans la noticeStructure de recherche
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National Health and Medical Research Council pays non établi dans la noticeOrganisme public
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Monash University NHMRC Centre of Clinical Research Excellence in Therapeutics pays non établi dans la noticeUniversité ou école supérieure
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Dallas VA Medical Center Department of Internal Medicine pays non établi dans la noticeÉtablissement de santé
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The University of Texas Southwestern Medical Center pays non établi dans la noticeÉtablissement de santé
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San Diego Cardiac Center pays non établi dans la noticeStructure de recherche
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University of Utah pays non établi dans la noticeUniversité ou école supérieure
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Pitié-Salpêtrière Hospital Pharmacology Department pays non établi dans la noticeÉtablissement de santé
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Columbia University Division of Circulatory Physiology pays non établi dans la noticeUniversité ou école supérieure
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University of Wisconsin–Madison pays non établi dans la noticeUniversité ou école supérieure
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Merck KGaA pays non établi dans la noticeEntreprise
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Nordic School of Public Health pays non établi dans la noticeUniversité ou école supérieure
Monash Alfred Psychiatry Research centre, National Health and Medical Research Council et NHMRC Centre of Clinical Research Excellence in Therapeutics — Monash University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.