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Robert A. Phillips, Arlene Travis, Alexander Butkevich, Maryann McLaughlin, Barbara Paris, Jonathan P. Greenblatt, Mohammad A. Rafey, P-372: Beta-blockade may improve diastolic dysfunction in the elderly. Trial to improve diastole in the elderly (TIDES) pilot study, American Journal of Hypertension, Volume 15, Issue S3, April 2002, Page 165A, https://doi.org/10.1016/S0895-7061(02)02723-1
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Abstract
The treatment for heart failure (CHF) due to diastolic dysfunction is not established. We conducted a pilot study on the effect of β-blockade on diastolic heart failure in the elderly.
18 subjects (15 women, 3 men; age 68±10 years) with fatigue or dyspnea on exertion not due to pulmonary disease and with normal systolic function were randomized to receive a β-blocker metoprolol XL or a placebo for 9 months, in addition to their medications. Heart failure scores, 6-min walk distance, 24-hour blood pressure (BP) and echocardiographic parameters were compared in the two groups at baseline and at 9 months.
Modified NHANES heart failure score improved significantly in the β-blocker group. 24-hour BP was not significantly different at baseline between the groups, and both groups had similar reductions in BP at 9 months. There was no significant change in 6-min walk or NYHA heart failure class in either group. Doppler E/A ratio tended to improve in the metoprolol XL group.
In summary, this data demonstrates that elderly subjects with CHF due to diastolic dysfunction can be identified and treated, and that β-blocker therapy improves signs and symptoms of CHF in this population. This pilot study provides the rationale for a large-scale trial of β-blockade in diastolic dysfunction. (See Table)
. | Placebo . | Metoprolol XL . | ||||
---|---|---|---|---|---|---|
. | Baseline . | 9 months . | P . | Baseline . | 9 months . | P . |
24-hour BP, mmHg | 131 ± 16/ 77 ± 16 | 116 ± 12/ 69 ± 6 | NS | 148 ± 19/ 83 ± 10 | 133 ± 11/ 73 ± 7 | NS/ 0.009 |
6 min walk, ft | 1007 ± 302 | 1036 ± 265 | NS | 1005 ± 305 | 991 ± 381 | NS |
E/A ratio | 0.74 ± 0.14 | 0.73 ± 0.15 | NS | 0.52 ± 0.21 | 0.69 ± 0.16 | NS |
NYHA class | 2.4 ± 0.5 | 2.3 ± 0.8 | NS | 2.3 ± 0.5 | 2.0 ± 0.6 | NS |
NHANES Score | 3.7 ± 0.8 | 2.7 ± 1.2 | NS | 3.8 ± 1.0 | 2.2 ± 0.8 | 0.025 |
. | Placebo . | Metoprolol XL . | ||||
---|---|---|---|---|---|---|
. | Baseline . | 9 months . | P . | Baseline . | 9 months . | P . |
24-hour BP, mmHg | 131 ± 16/ 77 ± 16 | 116 ± 12/ 69 ± 6 | NS | 148 ± 19/ 83 ± 10 | 133 ± 11/ 73 ± 7 | NS/ 0.009 |
6 min walk, ft | 1007 ± 302 | 1036 ± 265 | NS | 1005 ± 305 | 991 ± 381 | NS |
E/A ratio | 0.74 ± 0.14 | 0.73 ± 0.15 | NS | 0.52 ± 0.21 | 0.69 ± 0.16 | NS |
NYHA class | 2.4 ± 0.5 | 2.3 ± 0.8 | NS | 2.3 ± 0.5 | 2.0 ± 0.6 | NS |
NHANES Score | 3.7 ± 0.8 | 2.7 ± 1.2 | NS | 3.8 ± 1.0 | 2.2 ± 0.8 | 0.025 |
Data are mean ± SD.
. | Placebo . | Metoprolol XL . | ||||
---|---|---|---|---|---|---|
. | Baseline . | 9 months . | P . | Baseline . | 9 months . | P . |
24-hour BP, mmHg | 131 ± 16/ 77 ± 16 | 116 ± 12/ 69 ± 6 | NS | 148 ± 19/ 83 ± 10 | 133 ± 11/ 73 ± 7 | NS/ 0.009 |
6 min walk, ft | 1007 ± 302 | 1036 ± 265 | NS | 1005 ± 305 | 991 ± 381 | NS |
E/A ratio | 0.74 ± 0.14 | 0.73 ± 0.15 | NS | 0.52 ± 0.21 | 0.69 ± 0.16 | NS |
NYHA class | 2.4 ± 0.5 | 2.3 ± 0.8 | NS | 2.3 ± 0.5 | 2.0 ± 0.6 | NS |
NHANES Score | 3.7 ± 0.8 | 2.7 ± 1.2 | NS | 3.8 ± 1.0 | 2.2 ± 0.8 | 0.025 |
. | Placebo . | Metoprolol XL . | ||||
---|---|---|---|---|---|---|
. | Baseline . | 9 months . | P . | Baseline . | 9 months . | P . |
24-hour BP, mmHg | 131 ± 16/ 77 ± 16 | 116 ± 12/ 69 ± 6 | NS | 148 ± 19/ 83 ± 10 | 133 ± 11/ 73 ± 7 | NS/ 0.009 |
6 min walk, ft | 1007 ± 302 | 1036 ± 265 | NS | 1005 ± 305 | 991 ± 381 | NS |
E/A ratio | 0.74 ± 0.14 | 0.73 ± 0.15 | NS | 0.52 ± 0.21 | 0.69 ± 0.16 | NS |
NYHA class | 2.4 ± 0.5 | 2.3 ± 0.8 | NS | 2.3 ± 0.5 | 2.0 ± 0.6 | NS |
NHANES Score | 3.7 ± 0.8 | 2.7 ± 1.2 | NS | 3.8 ± 1.0 | 2.2 ± 0.8 | 0.025 |
Data are mean ± SD.