Dose of Metoprolol CR/XL and clinical outcomes in patients with heart failure -: Analysis of the experience in Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF)
Dose of Metoprolol CR/XL and clinical outcomes in patients with heart failure -: Analysis of the experience in Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF)
复制标题
DOI：
10.1016/s0735-1097(02)01970-8
复制
发表时间：
2002-08-07
影响因子：
24
通讯作者：
Wedel, H
中科院分区：
文献类型：
--
作者：
Wikstrand, J;Hjalmarson, Å;Wedel, H
目的 我们在慢性心力衰竭美托洛尔 CR/XL 随机干预试验 (MERIT-HF) 中进行了事后亚组分析，目的是报告滴定阶段的心率 (HR) 反应以及两个剂量亚组至研究结束的三个月随访的临床结果：其中一个剂量亚组每天一次达到超过 100 mg 美托洛尔 CR/XL（高剂量组；n = 1,202 毫克；平均 192 毫克）和一个已达到 100 毫克或更少的患者（低剂量组；n = 412；平均 76 毫克）。 背景 临床医生质疑患者是否需要达到目标 β 受体阻滞剂剂量才能受益。 方法 结果（Cox 调整）与三个月就诊时可用剂量的所有安慰剂患者 (n = 1,845) 进行比较。 结果 数据显示与高剂量组相比，低剂量组的风险略高。两个剂量组的心率降低程度相似，表明低剂量组对β-阻滞剂的敏感性更高。与安慰剂相比，美托洛尔 CR/XL 的总死亡率降低相似：高剂量组为 38%（95% 置信区间 [CI]，16 至 55）（p = 0.0022），低剂量组为 38%（95% CI，11 至 57）（p = 0.010）。 结论 高剂量组和低剂量组的风险降低相似从 HR 反应判断，这至少部分可能是类似 β 阻断的结果。结果支持个体化剂量滴定方案的想法，该方案以患者耐受性和 HR 反应为指导。需要进一步的研究来阐明为什么一些患者在使用相对小剂量的β受体阻滞剂后会出现心率显着降低并降低死亡风险的原因。 (C) 2002 年由美国心脏病学会基金会资助。
OBJECTIVES We performed a post-hoc subgroup analysis in the Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF) with the aim of reporting on the heart rate (HR) response during the titration phase and clinical outcomes from the three-month follow-up visit to end of study in two dosage subgroups: one that had reached more than 100 mg of metoprolol CR/XL once daily (high-dose group; n = 1,202; mean 192 mg) and one that had reached 100 mg or less (low-dose group; n = 412; mean 76 mg).BACKGROUND Clinicians have questioned whether patients need to reach the target beta-blocker dose to receive benefit.METHODS Outcome (Cox-adjusted) was compared with all placebo patients with dose available at the three-month visit (n = 1,845).RESULTS Data indicated somewhat higher risk in the low-dose group compared with the high-dose group. Heart rate was reduced to a similar degree in the two dose groups, indicating higher sensitivity for beta-blockade in the low-dose group. The reduction in total mortality with metoprolol CR/XL compared with placebo was similar: 38% (95% confidence interval [CI], 16 to 55) in high-dose group (p = 0.0022) and also 38% (95% Cl, 11 to 57) in the low-dose group (p = 0.010).CONCLUSIONS Risk reduction was similar in the high- and low-dose subgroups, which, at least partly, may be the result of similar beta-blockade as judged from the HR response. The results support the idea of an individualized dose-titration regimen, which is guided by patient tolerability and the HR response. Further research is needed to shed light on why some patients respond with a marked HR reduction and reduced mortality risk on a relatively small dose of a beta-blocker. (C) 2002 by the American College of Cardiology Foundation.