Clinical and hemodynamic efficacy of carvedilol in patients with congestive heart failure

Clinical and hemodynamic (assessed by echocardiography) effects of carvedilol were studied in 20 patients (18 men, 2 women, age 46 - 74, mean age 62,3+/-3,2 years) with NYHA class III-IV heart failure due to postinfarction cardiosclerosis and ejection fraction below 35%. Starting dose of carvedilol was 3,125 mg b.i.d with subsequent titration according to individual tolerance, reaction of blood pressure and heart rate using twofold increments (6,25, 12,5 and 25 mg b.i.d.) each two weeks. Duration of treatment was 3 months. By the end of this period the following changes occurred: significant reduction of NYHA functional class (from 3,5+/-0,1 to 2,7+/-0,1, p<0,01), improvement of tolerance to exercise (exercise time rose from 203+/-15,6 to 314,2+/-16,2 sec, p<0,05), increases of stroke volume (by 20%) and ejection fraction (by 14%), and lowering of total peripheral resistance (by 15%). Positive dynamics of 24-hour blood pressure profile was also observed: average 24-hour, day-and nighttime blood pressures and pressure burden were significantly lowered and the morning blood pressure elevation alleviated.-ln 2-4 hours after the first dose of carvedilol systolic and diastolic blood pressures decreased by 21%(p<0,05) and 18% (p<0,05), respectively. Thus the use of carvedilol in patients with heart failure was accompanied by positive changes of clinical and hemodynamic parameters.