Journal of cardiac failure
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Randomized Controlled Trial Clinical Trial
Consistency of the beneficial effect of metoprolol succinate extended release across a wide range dose of angiotensin-converting enzyme inhibitors and digitalis.
The effects of beta-blockade with different extent of angiotensin-converting enzyme inhibitors (ACEI) and digitalization are unknown. To assess the effect of metoprolol succinate controlled release/extended release (CR/XL) combined with high versus low doses of ACEI and digitalis, we analyzed data from The Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF) in which patients with heart failure and left ventricular ejection fraction < or =40% were randomized to metoprolol CR/XL versus placebo. ⋯ This analysis of MERIT-HF demonstrates consistent and similar improvement in outcome of patients receiving metoprolol CR/XL when combined with either a high or low dose of an ACEI or digitalis, or no digitalis at all. Thus regardless of ACEI and digitalis dose and whether patients are treated with digitalis or not, it is very important to add a beta-blocker to the existing heart failure therapy. beta-blockers should not be withheld until target doses of ACEI have been achieved.
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Structural remodeling of the left ventricle involves myocyte growth and matrix changes that result in chamber enlargement, contractile dysfunction and dyssynchrony. Clinical and experimental data document that these structural changes correlate with progressive worsening of the syndrome of heart failure, that the changes are preventable and reversible, and that a favorable clinical therapeutic response is associated with regression of remodeling. The growing evidence that structural remodeling represents the disease of heart failure has now fueled mechanical as well as pharmacologic approaches to inhibiting the remodeling.