The Carvedilol Prospective Randomiz...

The Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) consideration determined that at a mean follow-up of 104 month carvedilol, a beta-adrenergic blocker reduc death on 35 percent when compared with placebo. Krum and colleagues address matters that initiation of beta-blocker therapy in patients with heart failure may precipitate hypotension or worsening heart failure in the first four to eight weeks of therapy.

The COPERNICUS subject of attention randomized patients with severe heart failure to receive carvedilol, starting with a 3125-mg dosage twice daily and titrating upward to a target dosage of 25 mg twice daily, or placebo. All patients were treated with a diuretic and an angiotensin-converting enzyme inhibitor or angiotensin-II receptor antagonist.

Of the 2289 patients enlisted in the study, 1,133 were assigned to the placebo cluster and 1,156 to the carvedilol arrange During the first eight weeks, fewer patients in the carvedilol arrange died, were hospitalized, or permanently withdrew from carvedilol therapy than those in the placebo clump Similar findings were observed when analysis was applied solely to the highest-risk patients. Benefits began to appear as early as sum of two units to three weeks after initiation of carvedilol therapy.

The authors deduce that clinically euvolemic patients had no increased adverse purports from initiation and up-titration of carvedilol therapy. There were infrequent adverse side imports such as dizziness and bradycardia. The investigation also demonstrates the nearly immediate benefits of beta-adrenergic blockade.

Krum H et al. weights of initiating carvedilol in patients with methodical chronic heart failure. JAMA February 12 2003;289:712-8

CAROLINE WELLBERY, MD

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group