Do Beta Adrenoceptor Blocking Agents Provide the Same Degree of Clinically
Convincing Morbidity and Mortality Benefits in Patients with Chronic Heart
Failure

Martin Mumuni Danaah Malick

Abstract

Do Beta Adrenoceptor Blocking Agents Provide the Same Degree of Clinically Convincing Morbidity and Mortality Benefits in Patients with Chronic Heart Failure

Chronic heart failure has been extensively characterized as a disorder arising from a complex ÅÃÆÃ¢â¬Å¡ÃâÃÂnÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾ÆÃÆÃ¢â¬Å¡ÃâÃâÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡cÆÃÆÃ¢â¬Å¡ÃâÃÂ¸Å½n between impaired ventricular performance and neurohormonal ÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡cÆÃÆÃ¢â¬Å¡ÃâÃÂ¸ÇÃÆÃ¢â¬Å¡ÃâÃ¢âÂ¬ÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ¸Å½nÍÃÆÃ¢â¬Å¡ÃâÃÅ Since beta adrenoceptor blocking agents are currently considered an integral component of therapy for the management of ÆÃÆÃ¢â¬Å¡ÃâÃ¢â¬Â°ÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ¸ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ with severe chronic heart failure; several well designed clinical trials have been conducted to determine the morbidity and mortality bÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÄÃÆÃ¢â¬Å¡ÃâÃÂ¾Ä®ÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ of these agents. These studies however did not yield the same results in terms of morbidity and mortality bÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÄÃÆÃ¢â¬Å¡ÃâÃÂ¾Ä®ÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÆÃÆÃ¢â¬Å¡ÃâÃÂÍÃÆÃ¢â¬Å¡ÃâÃÅ Currently only Bisoprolol, Carvedilol and sustained release metoprolol succinate have clinically proven and convincing morbidity and mortality bÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÄÃÆÃ¢â¬Å¡ÃâÃÂ¾Ä®ÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÆÃÆÃ¢â¬Å¡ÃâÃÂÍÃÆÃ¢â¬Å¡ÃâÃÅ The current list of approved medicines of the NÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ¸Å½nÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡Å¯ Health Insurance Scheme (NHIS) of the republic of Ghana does not provide coverage for these live saving ÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÅÃÆÃ¢â¬Å¡ÃâÃÂ¡ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾ÆÃÆÃ¢â¬Å¡ÃâÃâÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡ÆÃÆÃ¢â¬Å¡ÃâÃ¢â¬Â°ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾ÆµÆÃÆÃ¢â¬Å¡ÃâÃÂ¸c agents. The Å½bÅ©ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾cÆÃÆÃ¢â¬Å¡ÃâÃÂ¸ÇÃÆÃ¢â¬Å¡ÃâÃ¢âÂ¬ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾ of this review is to collate the relevant ÆÃÆÃ¢â¬Å¡ÃâÃÂcÅÃÆÃ¢â¬Å¡ÃâÃÂÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÆÃÆÃ¢â¬Å¡ÃâÃÂ¸Ä®c evidence that will convince the ÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡ÆµÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÅÃÆÃ¢â¬Å¡ÃâÃÂ¡Å½ÆÃÆÃ¢â¬Å¡ÃâÃâÅÃÆÃ¢â¬Å¡ÃâÃÂÆÃÆÃ¢â¬Å¡ÃâÃÂ¸ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾ÆÃÆÃ¢â¬Å¡ÃâÃÂ at the NÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ¸Å½nÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡Å¯ Health Insurance Authority (NHIA) of the Republic of Ghana to include at least one of the evidence based beta adrenoceptor blocking agents in the list of approved medicines. A thorough search on the internet was conducted using Google scholar to obtain only the clinically relevant studies associated with the bÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÄÃÆÃ¢â¬Å¡ÃâÃÂ¾Ä®ÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ of beta adrenoceptor blocking agents in ÆÃÆÃ¢â¬Å¡ÃâÃ¢â¬Â°ÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ¸ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ with chronic heart failure published in the English language. The phrases beta adrenoceptor blocking agents and chronic heart failure were used as search engines. The search engine yielded several studies that met the ÆÃÆÃ¢â¬Å¡ÃâÃ¢â¬Â°ÆÃÆÃ¢â¬Å¡ÃâÃâÄÃÆÃ¢â¬Å¡ÃâÃÂ¾ÄÃÆÃ¢â¬Å¡ÃâÃÂ¡ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾Ä®nÄÃÆÃ¢â¬Å¡ÃâÃÂ¾ÄÃÆÃ¢â¬Å¡ÃâÃÂ¡ inclusion criteria. However, only the Cardiac /nÆÃÆÃ¢â¬Å¡ÃâÃÂÆµÄ¸cÅÃÆÃ¢â¬Å¡ÃâÃÂÄÃÆÃ¢â¬Å¡ÃâÃÂ¾ncÇÃÆÃ¢â¬Å¡ÃâÃ¢â¬Â¡ BIsoprolol Studies (CIBIS-I and CIBIS-II), Carvedilol WÆÃÆÃ¢â¬Å¡ÃâÃâÅ½ÆÃÆÃ¢â¬Å¡ÃâÃÂÆÃÆÃ¢â¬Å¡ÃâÃ¢â¬Â°ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾cÆÃÆÃ¢â¬Å¡ÃâÃÂ¸ÇÃÆÃ¢â¬Å¡ÃâÃ¢âÂ¬ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾ Randomized CÆµmÆµÅ¯ÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ¸ÇÃÆÃ¢â¬Å¡ÃâÃ¢âÂ¬ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾ Survival Study (COPERNICUS) and Metoprolol CR/XL Randomized /nÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾ÆÃÆÃ¢â¬Å¡ÃâÃâÇÃÆÃ¢â¬Å¡ÃâÃ¢âÂ¬ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÆÃÆÃ¢â¬Å¡ÃâÃÂ¸Å½n Trial (MERIF-HF) because of the clinical relevance of their Ä®nÄÃÆÃ¢â¬Å¡ÃâÃÂ¡ÅÃÆÃ¢â¬Å¡ÃâÃÂnÅÃÆÃ¢â¬Å¡ÃâÃÂÆÃÆÃ¢â¬Å¡ÃâÃÂ Beta adrenoceptor blocking agents such as atenolol and propranolol have been used in the management of ÆÃÆÃ¢â¬Å¡ÃâÃ¢â¬Â°ÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ¸ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ with chronic heart failure. However, their ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾Ä¸cÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡cÇÃÆÃ¢â¬Å¡ÃâÃ¢â¬Â¡ and Å½ÆÃÆÃ¢â¬Å¡ÃâÃ¢â¬Â°ÆÃÆÃ¢â¬Å¡ÃâÃÂ¸mÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡Å¯ dose in reducing mortality have not been ÆÃÆÃ¢â¬Å¡ÃâÃÂcÅÃÆÃ¢â¬Å¡ÃâÃÂÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÆÃÆÃ¢â¬Å¡ÃâÃÂ¸Ä®cÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡Å¯Å¯ÇÃÆÃ¢â¬Å¡ÃâÃ¢â¬Â¡ established Not all beta adrenoceptor blocking agents ÆÃÆÃ¢â¬Å¡ÃâÃÂcÅÃÆÃ¢â¬Å¡ÃâÃÂÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÆÃÆÃ¢â¬Å¡ÃâÃÂ¸Ä®cÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡Å¯Å¯ÇÃÆÃ¢â¬Å¡ÃâÃ¢â¬Â¡ studied provide the same degree of clinically meaningful and convincing morbidity and mortality bÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÄÃÆÃ¢â¬Å¡ÃâÃÂ¾Ä®ÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ in ÆÃÆÃ¢â¬Å¡ÃâÃ¢â¬Â°ÄÃÆÃ¢â¬Å¡ÃâÃ¢â¬Å¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ¸ÄÃÆÃ¢â¬Å¡ÃâÃÂ¾nÆÃÆÃ¢â¬Å¡ÃâÃÂ¡ÆÃÆÃ¢â¬Å¡ÃâÃÂ with chronic heart failure.

Author(s): Martin Mumuni Danaah Malick

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