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March 7, 2000 (Lake Worth, Fla.) — A new study shows that a blood-pressure
medication that physicians have traditionally been reluctant to use in people
with heart failure can significantly improve their chances of survival and
their quality of life.
The drug, Toprol XL (metoprolol), also shortened the amount of time these
people were hospitalized, which often happens when heart failure worsens, says
the study published in the March 8 issue of the Journal of the American
Medical Association.
Toprol XL belongs to a group of medications known as beta-blockers, which
have been used for years to treat high blood pressure and angina. Formerly,
physicians avoided using beta-blockers for patients with heart failure,
believing that the drugs would worsen symptoms because of their tendency to
decrease heart function. In the last several years, though, such drugs have
been used increasingly for people with heart failure, and more and more studies
have shown benefits for these patients.
“A beta-blocker is a drug that blocks the effects of adrenaline and
adrenaline-like substances,” says Jonathan Sackner-Bernstein, MD, who
reviewed the study for WebMD. Adrenaline and other hormones are useful in the
short run to protect the heart when it malfunctions, such as during a heart
attack, he explains. But in a patient with heart failure, the adrenaline system
remains active and can gradually damage the heart.
The study looked at heart failure patients on traditional drug therapy, with
the addition of either Toprol XL or a placebo. It showed that death and
hospitalization from all causes, including heart attack and worsening heart
failure, were reduced by 19% with the Toprol XL, writes author Ake Hjalmarson,
MD, PhD. Hjalmarson is with the department of cardiology at Sahlgrenska
University Hospital in Goteborg, Sweden.
The therapy also showed a beneficial effect on patients’ overall well-being,
the study’s authors write.
“So a beta-blacker blocks the adrenaline and gives it a little
protective coat that blocks the adrenaline from having deleterious
effects,” says Sackner-Bernstein, associate chief of the division of
cardiology and director of the Heart Failure Program at St. Luke’s-Roosevelt
Hospital in New York.
The study is one of the largest of its kind to look at beta-blocker therapy,
involving nearly 4,000 patients from 14 countries. It was supported by grants
from AstraZeneca, the manufacturer of Toprol XL.
Sackner-Bernstein says that people with heart failure need four things: a
diuretic to reduce excessive water retention; an ACE-inhibitor that blocks
angiotensin II, another substance like adrenaline that weakens the heart
muscle; digoxin, which increases heart muscle contraction; and a beta-blocker
like Toprol XL. Another beta-blocker that has been used in heart failure
patients is Coreg (carvedilol).
Earlier therapy for heart failure improved the patients’ symptoms but did
not necessarily extend their lives or improve their quality of life. Andrew
Smith, MD, tells WebMD that beta-blocker treatment requires close work between
patient and physician. It’s important for patients not to stop the therapy
suddenly, because it can cause dangerously high blood pressure and a sudden
worsening of heart failure.